Detection of cerebral {beta}-hydroxy butyrate, acetoacetate, and lactate on proton MR spectroscopy in children with diabetic ketoacidosis.
OBJECTIVE
Ketone bodies provide important alternate fuel for brain metabolism, and their transport into the brain increases with prolonged fasting. During diabetic ketoacidosis (DKA), serum ketone concentrations markedly increase; however, little is known about whether ketone bodies accumulate in cerebral tissues during DKA. We used proton MR spectroscopy (MRS) to detect cerebral beta-hydroxy butyrate (betaOHB) and acetone/acetocaetate (AcAc) in children with DKA.


METHODS
Twenty-five children underwent brain MRS: nine within 4 hours of the start of treatment for DKA; 11, at 4-8 hours; and five, at 8-12 hours. MRS was repeated after their recovery from the DKA episode at > or =72 hours after the start of treatment. MRS was evaluated for peaks corresponding to betaOHB (doublet centered on 1.20 ppm) and lactate (doublet centered on 1.33 ppm). Difference spectroscopy was used to identify the AcAc peak at 2.22-2.26 ppm.


RESULTS
betaOHB was detected in 13 children (52%), more frequently within 4 hours (eight children, 89%) than after 4 hours (five children, 31%). AcAc was detected in 15 children (60%), more frequently at >4 hours after the start of treatment (12 patients, 75%) than in the first 4 hours (three patients, 33%). Lactate was detected in five children (18%), all within the first 8 hours of treatment.


CONCLUSIONS
In children, betaOHB and AcAc accumulate in the brain during DKA, and they can be detected on MRS. Care should be taken in interpreting MRS results in patients with DKA to avoid erroneously attributing betaOHB peaks to lactate.
Wootton-Gorges
Sandra L
SL
Department Radiology, University of California, Davis School of Medicine, Sacramento, CA 95817, USA.
Buonocore
Michael H
MH
Kuppermann
Nathan
N
Marcin
James
J
Dicarlo
Joseph
J
Neely
E Kirk
EK
Barnes
Patrick D
PD
Glaser
Nicole
N
D020155:3-Hydroxybutyric Acid / Q000032:analysis* / Q000378:metabolism; D000090:Acetoacetates / Q000032:analysis* / Q000378:metabolism; D002648:Child; D016883:Diabetic Ketoacidosis / Q000378:metabolism*; D005260:Female; D006801:Humans; D019344:Lactic Acid / Q000032:analysis* / Q000378:metabolism; D009682:Magnetic Resonance Spectroscopy; D008297:Male
D000090:Acetoacetates; D019344:Lactic Acid; C016635:acetoacetic acid; D020155:3-Hydroxybutyric Acid