How can the risk of developing cerebral edema during the treatment of pediatric DKA be decreased?

• rehydrate but don't over do it
• do not give an initial bolus of insulin
  
• delay insulin drip administration for one hour or more after initiation of fluid therapy
• avoid bicarbonate therapy if possible
  

The mechanisms responsible for cerebral edema are poorly understood. It is generally believed that cerebral edema is related to the management of DKA and several factors, noted above, have been implicated but none has been definitively proven.

Source

Jeha, G. and Haymond, M. "Cerebral edema in children with diabetic ketoacidosis" Up to Date. 12 Jan 2009.

Jeha, G. and Haymond, M. "Treatment and complications of diabetic ketoacidosis in children" Up to Date. 15 Oct 2009.