title: Frequency of sub-clinical cerebral edema in children with diabetic ketoacidosis.
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.
authors.affiliation: Department of Pediatrics, University of California Davis School of Medicine, Sacramento 95817, USA. nsglaser@ucdavis.edu
authors.forename: Nicole S
authors.initials: NS
authors.lastname: Glaser
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Wootton-Gorges
authors.forename: Michael H
authors.initials: MH
authors.lastname: Buonocore
authors.forename: James P
authors.initials: JP
authors.lastname: Marcin
authors.forename: Arleta
authors.initials: A
authors.lastname: Rewers
authors.forename: John
authors.initials: J
authors.lastname: Strain
authors.forename: Joseph
authors.initials: J
authors.lastname: DiCarlo
authors.forename: E Kirk
authors.initials: EK
authors.lastname: Neely
authors.forename: Patrick
authors.initials: P
authors.lastname: Barnes
authors.forename: Nathan
authors.initials: N
authors.lastname: Kuppermann
mesh_terms: D000293:Adolescent; D001786:Blood Glucose / Q000032:analysis; D001806:Blood Urea Nitrogen; D001929:Brain Edema / Q000175:diagnosis* / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D002552:Cerebral Ventricles / Q000033:anatomy & histology; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D016883:Diabetic Ketoacidosis / Q000097:blood / Q000150:complications*; D005260:Female; D006261:Headache / Q000209:etiology; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008279:Magnetic Resonance Imaging; D008297:Male
chemical_list: D001786:Blood Glucose