Hyperemia and impaired cerebral autoregulation in a surgical patient with diabetic ketoacidosis.
OBJECTIVE
We describe cerebral hyperemia and impaired cerebral autoregulation documented with transcranial Doppler (TCD) ultrasonography in an adult patient with diabetic ketoacidosis (DKA) and sepsis presenting for surgery.


METHODS
Middle cerebral artery flow velocity was increased relative to PaCO(2) (Vmca 52 cm.sec(-1); PaCO(2) 22 mmHg) and the autoregulatory index (ARI) was 0 prior to surgery. Twenty hours after admission and treatment, cerebral hyperemia resolved (Vmca 52 cm.sec(-1) ; PaCO(2) 35 mmHg) and cerebral autoregulation returned to normal (ARI 0.91).


CONCLUSIONS
To our knowledge, this is the first description of impaired cerebral autoregulation in adult DKA. Our observations suggest a relationship between cerebral hyperemia and impaired cerebral autoregulation in DKA.
Vavilala
Monica S
MS
Department of Anesthesiology, Harborview Medical Center, 325 Ninth Avenue, Box 359724, Seattle, Washington 98104, USA. vavilala@u.washington.edu
Souter
Michael J
MJ
Lam
Arthur M
AM
D000038:Abscess / Q000601:surgery; D000328:Adult; D002245:Carbon Dioxide / Q000097:blood; D002560:Cerebrovascular Circulation; D016883:Diabetic Ketoacidosis / Q000503:physiopathology*; D006706:Homeostasis; D006801:Humans; D006940:Hyperemia / Q000503:physiopathology*; D008297:Male; D017585:Ultrasonography, Doppler, Transcranial
D002245:Carbon Dioxide