Relation of Colloid Osmotic Pressure to Arterial Hypoxemia and Cerebral Edema During Crystalloid Volume Loading of Patients with Diabetic Ketoacidosis

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Abstract
The effect of crystalloid volume loading on serum colloid osmotic pressure, arterial O2 (PO2), alveolar-arterial O2 gradient (A-aDO2) and cerebral lateral ventricle dimensions was prospectively studied in 18 patients with diabetic ketoacidosis. Serial measurements showed concomitant decreases in colloid osmotic pressure, hematocrit, arterial PO2 (P < 0.001), and significant increases in A-aDO2 (P < 0.001) during treatment. Serial echoencephalograms were taken of 11 of the 18 patients; each patient served as his or her own control. Nine of these 11 patients showed significant decreases in lateral ventricle width during treatment; 7 patients showed the echoencephalographic hash marks characteristic of cerebral edema. Follow-up studies showed resolution of these abnormalities. Volume loading with large amounts of crystalloid solution seems to produce an acute hypo-oncotic state that may cause the development of both subclinical pulmonary and cerebral edema.