title: Diabetic ketoacidosis and electroencephalographic changes in newly diagnosed pediatric patients.
abstract: To document electroencephalogram (EEG) changes and their correlation with clinical parameters in a newly diagnosed pediatric cohort of type 1 diabetes mellitus (T1DM) patients with and without diabetic ketoacidosis (DKA) and to define their medium term utility and significance.
  
  
  
  Prospective longitudinal study of children presenting with T1DM. EEGs were performed within 24 h of diagnosis, day 5, and at 6 months post-diagnosis and reviewed by a neurologist blinded to clinical status. Severity of encephalopathy was graded from 1 to 5 using the Aoki and Lombroso encephalopathy scale. Cognitive abilities were assessed using standardized tests of attention, memory, and intelligence.
  
  
  
  Eighty eight children were recruited; 34 presented with DKA. Abnormal background slowing was more often observed in the first 24 h in children with DKA (p = 0.01). Encephalopathy scores on day 1 correlated with initial pH, CO2 , HCO3 , base excess, respiratory rate, heart rate, diastolic blood pressure, and IV fluid intake (all parameters p < 0.05). EEG scores at day 1 did not correlate with contemporaneous mental state or cognition in the medium term.
  
  
  
  DKA was associated with significant clinical and neurophysiologic signs of brain dysfunction at presentation. While EEG is sensitive to the detection of encephalopathy in newly diagnosed T1DM, it has limited use in identifying children at risk of later cognitive deficits.
authors.affiliation: Department of Neurology, Royal Children's Hospital, Melbourne, Victoria, Australia.
authors.forename: Mark T
authors.initials: MT
authors.lastname: Mackay
authors.affiliation: Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Molesworth
authors.affiliation: Department of Psychology, Royal Children's Hospital, Melbourne, Victoria, Australia.|Department of Endocrinology and Diabetes, Royal Children's Hospital, Melbourne, Victoria, Australia.
authors.forename: Elisabeth A
authors.initials: EA
authors.lastname: Northam
authors.affiliation: Washington University, St Louis, MO, USA.
authors.forename: Terrie E
authors.initials: TE
authors.lastname: Inder
authors.affiliation: Department of Endocrinology and Diabetes, Royal Children's Hospital, Melbourne, Victoria, Australia.|Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Fergus J
authors.initials: FJ
authors.lastname: Cameron
mesh_terms: D000293:Adolescent; D001921:Brain / Q000503:physiopathology*; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D016883:Diabetic Ketoacidosis / Q000209:etiology / Q000503:physiopathology*; D004569:Electroencephalography; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011446:Prospective Studies
keywords: DKA; EEG; brain