Early-onset cerebral edema in adult **diabetic ketoacidosis** resolves completely with standard medical therapy.

Diabetic Ketoacidosis (DKA) is a severe, life-threatening complication of diabetes characterized by hyperglycemia, ketosis, and metabolic acidosis. While common, cerebral oedema is a rare and often fatal complication, predominantly reported in pediatric DKA. Its occurrence in adults is poorly understood and frequently under-recognized, leading to delayed diagnosis and intervention. Current understanding often links adult cerebral oedema to rapid fluid shifts or aggressive insulin therapy during DKA treatment, rather than the DKA state itself. This case highlights the need to re-evaluate the direct role of DKA in its pathogenesis.

This case report details a woman in her late 20s presenting to the emergency department with severe Diabetic Ketoacidosis (DKA) and altered mental status. Initial diagnostic imaging, specifically a CT scan, revealed diffuse cerebral oedema with effacement of sulci and basal cisterns. The patient received standard DKA management, including fluid resuscitation, insulin infusion, and hyperosmolar therapy. No neurosurgical intervention was required. The primary endpoint was the resolution of cerebral oedema and neurological recovery, monitored through clinical status and follow-up imaging.

The most significant finding was the identification of diffuse cerebral oedema before significant metabolic correction had occurred, challenging the common assumption that it is solely a complication of DKA treatment. This suggests cerebral oedema may be a direct consequence of the severe DKA state itself. Her altered mental status resolved as her metabolic parameters normalized. This outcome underscores that early recognition and prompt initiation of standard medical therapies, including fluid resuscitation, insulin infusion, and hyperosmolar therapy, can lead to complete neurological recovery even in severe cases of adult DKA-associated cerebral oedema. > The patient recovered fully without neurosurgical intervention, demonstrating complete resolution of the cerebral oedema.