Subclinical cerebral edema in children with diabetic ketoacidosis randomized to 2 different rehydration protocols

Nicole Glaser, Sandra L. Wootton-Gorges, Michael H. Buonocore, Daniel J Tancredi, James P Marcin, Ryan Caltagirone, Yvonne Lee, Christopher Murphy, Nathan Kuppermann

Research output: Contribution to journalArticle

31 Scopus citations

Abstract

OBJECTIVE: Previous studies show that vasogenic cerebral edema (CE) occurs during diabetic ketoacidosis (DKA) treatment in children, but the role of intravenous fluids in contributing to CE is unclear. We used magnetic resonance diffusion weighted imaging to quantify subclinical CE in children with DKA randomized to 2 intravenous fluid regimens. METHODS: Children with DKA were randomized to receive fluids at a more rapid rate (n = 8) or a slower rate (n = 10), with all other aspects of DKA treatment kept identical. Children underwent diffusion weighted imaging 3 to 6 hours and 9 to 12 hours after beginning DKA treatment and after recovery from DKA (≥72 hours after beginning treatment). We calculated brain apparent diffusion coefficient (ADC) values as the average of measurements in the basal ganglia, thalamus, frontal white matter, and hippocampus and determined the mean brain ADC value during DKA treatment by averaging data from the 3- to 6-hour and 9- to 12-hour measurements. The difference in mean brain ADC between DKA treatment and postrecovery was used as an index of the severity of CE during DKA treatment. RESULTS: Mean brain ADC values during DKA treatment were significantly higher than postrecovery values, consistent with vasogenic CE (842 ± 38 vs 800 ± 41×10 -6 mm2/second, P = .002). We did not detect significant differences in ADC elevation in children treated with more rapid versus slower rehydration (β coefficient 0.11 for 1 SD change in ADC, 95% confidence interval: -0.91 to 1.13). CONCLUSIONS: ADC changes during DKA treatment (reflective of vasogenic CE) do not appear to be substantially affected by the rate of intravenous fluid administration. Pediatrics 2013;131:e73-e80.

Original languageEnglish (US)
JournalPediatrics
Volume131
Issue number1
DOIs
StatePublished - Jan 2013

Keywords

  • Cerebral edema
  • Cerebral injury
  • Diabetic ketoacidosis
  • Diffusion weighted imaging
  • MRI

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Arts and Humanities (miscellaneous)

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