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

I. ALAN FEIN, M.D.; ERIC C. RACKOW, M.D.; CHARLES L. SPRUNG, M.D.; and RICHARD GRODMAN, M.D.
[+] Article and Author Information

▸Requests for reprints should be addressed to Eric C. Rackow, M.D.; Critical Care Center, Ellis Hospital, 1101 Nott Street; Schenectady, NY 12308.


Schenectady, New York


©1982 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1982;96(5):570-575. doi:10.7326/0003-4819-96-5-570
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The effect of crystalloid volume loading on serum colloid osmotic pressure, arterial oxygen (Po2), alveolar-arterial oxygen 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; seven 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 hypooncotic state that may cause the development of both subclinical pulmonary and cerebral edema.

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