title: Cerebral hyperemia measured with near infrared spectroscopy during treatment of diabetic ketoacidosis in children.
abstract: OBJECTIVE
  To use near infrared spectroscopy (NIRS) to evaluate the timing of onset and duration of cerebral hyperemia during diabetic ketoacidosis (DKA) treatment in children, and to investigate the relationship of cerebral hyperemia to intravenous fluid treatment.
  
  
  METHODS
  We randomized children aged 8-18 years with DKA to either more rapid or slower intravenous fluid treatment (19 total DKA episodes). NIRS was used to measure rSo2 during DKA treatment. NIRS monitoring began as soon as informed consent was obtained and continued until the patient was transferred out of the critical care unit.
  
  
  RESULTS
  rSo2 values above the normal range (>80%) were detected in 17 of 19 DKA episodes (mean rSo2 during initial 8 hours of DKA treatment: 86% ± 7%, range 65%-95%). Elevated rSo2 values were detected as early as the second hour of DKA treatment and persisted for as long as 27 hours. Hourly mean rSo2 levels during treatment did not differ significantly by fluid treatment group.
  
  
  CONCLUSIONS
  During DKA treatment, children have elevated rSo2 values consistent with cerebral hyperemia. Hyperemia occurs as early as the second hour of DKA treatment and may persist for ≥ 27 hours. Cerebral rSo2 levels during treatment did not differ significantly in patients treated with slower versus more rapid intravenous rehydration.
authors.affiliation: Department of Pediatrics, University of California Davis, School of Medicine, Sacramento, CA. Electronic address: nsglaser@ucdavis.edu.
authors.forename: Nicole S
authors.initials: NS
authors.lastname: Glaser
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; D001921:Brain / Q000473:pathology; D002560:Cerebrovascular Circulation; D002561:Cerebrovascular Disorders / Q000150:complications / Q000175:diagnosis / Q000473:pathology; D002648:Child; D016883:Diabetic Ketoacidosis / Q000150:complications / Q000473:pathology* / Q000628:therapy*; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D006940:Hyperemia / Q000150:complications / Q000175:diagnosis* / Q000473:pathology*; D007262:Infusions, Intravenous; D016014:Linear Models; D008297:Male; D019265:Spectroscopy, Near-Infrared; D013997:Time Factors
keywords: CBF; Cerebral blood flow; DKA; Diabetic ketoacidosis; MRI; Magnetic resonance imaging; NIRS; Near infrared spectroscopy; Regional cerebral oxygen saturation; rSo(2)