Change in blood-brain barrier permeability during pediatric diabetic ketoacidosis treatment.
OBJECTIVE
Cerebral edema is a devastating complication of pediatric diabetic ketoacidosis. We aimed to examine blood-brain barrier permeability during treatment of diabetic ketoacidosis in children.


METHODS
Prospective observational study.


METHODS
Seattle Children's Hospital, Seattle, WA.


METHODS
Children admitted with diabetic ketoacidosis (pH <7.3, HCO3 <15 mEq/L, glucose >300 mg/dL, and ketosis).


METHODS
None.


RESULTS
Subjects underwent two serial paired contrast-enhanced perfusion (gadolinium) and diffusion magnetic resonance imaging scans. Change in whole brain and regional blood-brain barrier permeability (permeability ratio*100 and % permeability ratio change) between illness and recovery were determined. Time 0 reflects start of insulin treatment. Thirteen children (median age 10.0 +/- 1.1 yrs; seven female) with diabetic ketoacidosis were enrolled. Permeability ratio increased from time 1 (first magnetic resonance image after time 0) to time 2 (second magnetic resonance image after time 0) in the frontal cortex (ten of 13 subjects), occipital cortex (ten of 13 subjects), and basal ganglia (nine of 13). Whole brain permeability ratio increased from time 1 to time 2 (160%) and regional increase in permeability ratio was greatest in the frontal cortex (148%) compared with the occipital cortex (128%) and basal ganglia (112%).


CONCLUSIONS
Overall, whole brain and regional blood-brain barrier permeability increased in most subjects during diabetic ketoacidosis treatment. The frontal region had more blood-brain barrier permeability than other brain regions examined.
Department of Anesthesiology, University of Washington, Seattle, WA, USA. Vavilala@u.washington.edu
Monica S
MS
Vavilala
Todd L
TL
Richards
Joan S
JS
Roberts
Harvey
H
Chiu
Catherine
C
Pihoker
Heidi
H
Bradford
Kristina
K
Deeter
Ken I
KI
Marro
Dennis
D
Shaw
D000293:Adolescent; D001812:Blood-Brain Barrier / Q000378:metabolism* / Q000503:physiopathology*; D001921:Brain / Q000098:blood supply*; D001929:Brain Edema / Q000503:physiopathology; D002648:Child; D016883:Diabetic Ketoacidosis / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D010539:Permeability; D011446:Prospective Studies
D007004:Hypoglycemic Agents; D007328:Insulin