[Fatal cerebral oedema during the treatment of diabetic ketoacidosis in an adult male]. / Fataal hersenoedeem bij behandeling van een volwassene met diabetische ketoacidose.

Diabetic ketoacidosis is relatively common, but the optimal treatment of this condition is still controversial. Cerebral oedema is a rare, but potentially fatal complication. We present the case of an adult patient who presented with de novo diabetic ketoacidosis that was complicated by cerebral oedema during treatment. In this article we discuss factors that may have played a role in the development of this complication. A prolonged hyperosmolar state in diabetic ketoacidosis may increase the risk of cerebral oedema as a result of cerebral compensatory mechanisms. In this group of patients, liberal doses of insulin, fluids and bicarbonate may lead to a decrease in the effective serum osmolarity which can lead to water shifts in the cerebrum. We suggest several adjustments to current treatment guidelines for patients with diabetic ketoacidosis who have undergone a prolonged period of hyperosmolar derangement, with the aim of decreasing the risk of cerebral oedema.

Endoscopic treatment of a bile duct stone containing a surgical staple.

We report a case of a pigmented gallstone which formed around a surgical staple in the bile duct. The stone was removed and retrieved endoscopically. A brief review of bile duct foreign bodies and gallstones is presented.