title: Correlation of clinical and biochemical findings with diabetic ketoacidosis-related cerebral edema in children using magnetic resonance diffusion-weighted imaging.
abstract: OBJECTIVE
  To determine clinical and biochemical factors influencing cerebral edema formation during diabetic ketoacidosis (DKA) in children.
  
  
  METHODS
  We used magnetic resonance diffusion-weighted imaging to quantify edema formation. We measured the apparent diffusion coefficient (ADC) of brain water during and after DKA treatment in 26 children and correlated ADC changes with clinical and biochemical variables.
  
  
  RESULTS
  Mean ADC values were elevated during DKA treatment compared with baseline (8.13 +/- 0.47 vs 7.74 +/- 0.49 x 10(-4) mm(2)/sec, difference in means 0.40, 95% CI: 0.25 to 0.55, P < .001). Children with altered mental status during DKA had greater elevation in ADC. ADC elevation during DKA was positively correlated with initial serum urea nitrogen concentration (correlation coefficient 0.41, P = .03) and initial respiratory rate (correlation coefficient 0.61, P < .001). ADC elevation was not significantly correlated with initial serum glucose, sodium or effective osmolality, nor with changes in glucose, sodium or osmolality during treatment. Multivariable analyses identified the initial urea nitrogen concentration and respiratory rate as independently associated with ADC elevation.
  
  
  CONCLUSIONS
  The degree of edema formation during DKA in children is correlated with the degree of dehydration and hyperventilation at presentation, but not with factors related to initial osmolality or osmotic changes during treatment. These data support the hypothesis that CE is related to cerebral hypoperfusion during DKA, and that osmotic fluctuations during DKA treatment do not play a primary causal role.
authors.affiliation: Department of Pediatrics, University of California, Davis School of Medicine, Sacramento, CA 95817, USA. nsglaser@ucdavis.edu
authors.forename: Nicole S
authors.initials: NS
authors.lastname: Glaser
authors.forename: James P
authors.initials: JP
authors.lastname: Marcin
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Wootton-Gorges
authors.forename: Michael H
authors.initials: MH
authors.lastname: Buonocore
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: D001929:Brain Edema / Q000209:etiology* / Q000378:metabolism / Q000503:physiopathology*; D002648:Child; D003681:Dehydration; D016883:Diabetic Ketoacidosis / Q000150:complications*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D006985:Hyperventilation; D008279:Magnetic Resonance Imaging / Q000379:methods*; D015999:Multivariate Analysis; D009994:Osmolar Concentration; D012119:Respiration