Frequency of sub-clinical cerebral edema in children with diabetic ketoacidosis

Nicole Glaser, Sandra L. Wootton-Gorges, Michael H. Buonocore, James P Marcin, Arleta Rewers, John Strain, Joseph DiCarlo, E. Kirk Neely, Patrick Barnes, Nathan Kuppermann

Research output: Contribution to journalArticle

100 Citations (Scopus)

Abstract

Symptomatic cerebral edema occurs in approximately 1% of children with diabetic ketoacidosis (DKA). However, asymptomatic or subclinical cerebral edema is thought to occur more frequently. Some small studies have found narrowing of the cerebral ventricles indicating cerebral edema in most or all children with DKA, but other studies have not detected narrowing in ventricle size. In this study, we measured the intercaudate width of the frontal horns of the lateral ventricles using magnetic resonance imaging (MRI) in children with DKA during treatment and after recovery from the DKA episode. We determined the frequency of ventricular narrowing and compared clinical and biochemical data for children with and without ventricular narrowing. Forty-one children completed the study protocol. The lateral ventricles were significantly smaller during DKA treatment (mean width, 9.3 ± 0.3 vs. 10.2 ± 0.3 mm after recovery from DKA, p < 0.001). Children with ventricular narrowing during DKA treatment (22 children, 54%) were more likely to have mental status abnormalities than those without narrowing [12/22 vs. 4/19 with Glasgow Coma Scale (GCS) scores below 15 during therapy, p = 0.03]. Multiple logistic regression analysis revealed that a lower initial PCO2 level was significantly associated with ventricular narrowing [odds ratio (OR) = 0.88,95% confidence interval (95% CI) = 0.78-0.99, p = 0.047). No other variables analyzed were associated with ventricular narrowing in the multivariate analysis. We conclude that narrowing of the lateral ventricles is evident in just over half of children being treated for DKA. Although children with ventricular narrowing did not exhibit neurological abnormalities sufficient for a diagnosis of 'symptomatic cerebral edema', mild mental status abnormalities occurred frequently, suggesting that clinical evidence of cerebral edema in children with DKA may be more common than previously reported.

Original languageEnglish (US)
Pages (from-to)75-80
Number of pages6
JournalPediatric Diabetes
Volume7
Issue number2
DOIs
StatePublished - May 2006

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Diabetic Ketoacidosis
Brain Edema
Lateral Ventricles
Cerebral Ventricles
Glasgow Coma Scale
Therapeutics
Horns
Multivariate Analysis
Logistic Models
Odds Ratio
Regression Analysis
Magnetic Resonance Imaging
Confidence Intervals

Keywords

  • Cerebral edema
  • Cerebral ventricles
  • DKA

ASJC Scopus subject areas

  • Internal Medicine
  • Pediatrics, Perinatology, and Child Health
  • Endocrinology, Diabetes and Metabolism

Cite this

Frequency of sub-clinical cerebral edema in children with diabetic ketoacidosis. / Glaser, Nicole; Wootton-Gorges, Sandra L.; Buonocore, Michael H.; Marcin, James P; Rewers, Arleta; Strain, John; DiCarlo, Joseph; Neely, E. Kirk; Barnes, Patrick; Kuppermann, Nathan.

In: Pediatric Diabetes, Vol. 7, No. 2, 05.2006, p. 75-80.

Research output: Contribution to journalArticle

Glaser, N, Wootton-Gorges, SL, Buonocore, MH, Marcin, JP, Rewers, A, Strain, J, DiCarlo, J, Neely, EK, Barnes, P & Kuppermann, N 2006, 'Frequency of sub-clinical cerebral edema in children with diabetic ketoacidosis', Pediatric Diabetes, vol. 7, no. 2, pp. 75-80. https://doi.org/10.1111/j.1399-543X.2006.00156.x
Glaser, Nicole ; Wootton-Gorges, Sandra L. ; Buonocore, Michael H. ; Marcin, James P ; Rewers, Arleta ; Strain, John ; DiCarlo, Joseph ; Neely, E. Kirk ; Barnes, Patrick ; Kuppermann, Nathan. / Frequency of sub-clinical cerebral edema in children with diabetic ketoacidosis. In: Pediatric Diabetes. 2006 ; Vol. 7, No. 2. pp. 75-80.
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abstract = "Symptomatic cerebral edema occurs in approximately 1{\%} of children with diabetic ketoacidosis (DKA). However, asymptomatic or subclinical cerebral edema is thought to occur more frequently. Some small studies have found narrowing of the cerebral ventricles indicating cerebral edema in most or all children with DKA, but other studies have not detected narrowing in ventricle size. In this study, we measured the intercaudate width of the frontal horns of the lateral ventricles using magnetic resonance imaging (MRI) in children with DKA during treatment and after recovery from the DKA episode. We determined the frequency of ventricular narrowing and compared clinical and biochemical data for children with and without ventricular narrowing. Forty-one children completed the study protocol. The lateral ventricles were significantly smaller during DKA treatment (mean width, 9.3 ± 0.3 vs. 10.2 ± 0.3 mm after recovery from DKA, p < 0.001). Children with ventricular narrowing during DKA treatment (22 children, 54{\%}) were more likely to have mental status abnormalities than those without narrowing [12/22 vs. 4/19 with Glasgow Coma Scale (GCS) scores below 15 during therapy, p = 0.03]. Multiple logistic regression analysis revealed that a lower initial PCO2 level was significantly associated with ventricular narrowing [odds ratio (OR) = 0.88,95{\%} confidence interval (95{\%} CI) = 0.78-0.99, p = 0.047). No other variables analyzed were associated with ventricular narrowing in the multivariate analysis. We conclude that narrowing of the lateral ventricles is evident in just over half of children being treated for DKA. Although children with ventricular narrowing did not exhibit neurological abnormalities sufficient for a diagnosis of 'symptomatic cerebral edema', mild mental status abnormalities occurred frequently, suggesting that clinical evidence of cerebral edema in children with DKA may be more common than previously reported.",
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