title: Subclinical cerebral edema in children with diabetic ketoacidosis randomized to 2 different rehydration protocols.
abstract: OBJECTIVE
  Previous studies show that vasogenic cerebral edema (CE) occurs during diabetic ketoacidosis (DKA) treatment in children, but the role of intravenous fluids in contributing to CE is unclear. We used magnetic resonance diffusion weighted imaging to quantify subclinical CE in children with DKA randomized to 2 intravenous fluid regimens.
  
  
  METHODS
  Children with DKA were randomized to receive fluids at a more rapid rate (n = 8) or a slower rate (n = 10), with all other aspects of DKA treatment kept identical. Children underwent diffusion weighted imaging 3 to 6 hours and 9 to 12 hours after beginning DKA treatment and after recovery from DKA (≥ 72 hours after beginning treatment). We calculated brain apparent diffusion coefficient (ADC) values as the average of measurements in the basal ganglia, thalamus, frontal white matter, and hippocampus and determined the mean brain ADC value during DKA treatment by averaging data from the 3- to 6-hour and 9- to 12-hour measurements. The difference in mean brain ADC between DKA treatment and postrecovery was used as an index of the severity of CE during DKA treatment.
  
  
  RESULTS
  Mean brain ADC values during DKA treatment were significantly higher than postrecovery values, consistent with vasogenic CE (842 ± 38 vs 800 ± 41 × 10(-6) mm(2)/second, P = .002). We did not detect significant differences in ADC elevation in children treated with more rapid versus slower rehydration (β coefficient 0.11 for 1 SD change in ADC, 95% confidence interval: -0.91 to 1.13).
  
  
  CONCLUSIONS
  ADC changes during DKA treatment (reflective of vasogenic CE) do not appear to be substantially affected by the rate of intravenous fluid administration.
authors.affiliation: Department of Pediatrics, School of Medicine, University of California Davis, Davis, California, 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: Daniel J
authors.initials: DJ
authors.lastname: Tancredi
authors.forename: James P
authors.initials: JP
authors.lastname: Marcin
authors.forename: Ryan
authors.initials: R
authors.lastname: Caltagirone
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Lee
authors.forename: Christopher
authors.initials: C
authors.lastname: Murphy
authors.forename: Nathan
authors.initials: N
authors.lastname: Kuppermann
mesh_terms: D000293:Adolescent; D001929:Brain Edema / Q000139:chemically induced* / Q000175:diagnosis / Q000378:metabolism*; D002648:Child; D016883:Diabetic Ketoacidosis / Q000378:metabolism* / Q000628:therapy*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D010865:Pilot Projects