Cerebral Edema and Diabetic Ketoacidosis

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To the editor: We write to comment on the article by Fein and associates (1). From information reported by Clements and colleagues (2), which confirmed our own observations, we suspect that an element of "benign" cerebral edema occurs quite frequently, if not routinely, during successful treatment of uncontrolled diabetes. In fact, it used to be common to expect deterioration of the initial state of consciousness in 10% to 15% of diabetic patients in ketoacidosis early in therapy. This event is much less common currently with low-dose insulin regimens; early potassium, phosphate, and magnesium replacement; and large volumes of crystalloid infusions.