title: Serial optic nerve sheath diameter ultrasonography during pediatric diabetic ketoacidosis management: A pilot study.
abstract: Intracranial hypertension is an infrequent but serious acute complication of pediatric diabetic ketoacidosis (DKA). Subclinical elevations of intracranial pressures however, may be more common, and can be indirectly evaluated with ultrasonography of the optic nerve sheath diameter (ONSD). In this pilot study, we report serial data on ONSD trajectories from five pediatric patients with DKA to generate hypotheses for future studies.
  
  
  
  Five pediatric patients with type 1 diabetes presented to our emergency department with DKA and enrolled in our study <3h after initiation of treatment. Ultrasonographic evaluation of the ONSD was conducted at presentation, every three hours until resolution of acidosis, and finally 24h post presentation. Following each interval evaluation, a clinical bedside neurologic tool developed for detecting cerebral edema in DKA was utilized.
  
  
  
  Four of the five patients exhibited a similar "bell" shaped trajectory - an increase of ONSD after initiation of treatment followed by a return to admission baseline. Patients demonstrated peak ONSDs nine and twelve hours after DKA therapy was initiated, at resolution of acidosis, and at admission. No children exhibited clinical signs suggestive of cerebral edema.
  
  
  
  Peak ONSDs cannot be reliability determined in children with DKA unless serial investigations are conducted. Practices to mitigate risks for intracranial hypertension may require constant surveillance during DKA management.
authors.affiliation: Section of Pediatric Intensive Care, Department of Pediatrics and Child Health, University of Manitoba, Children's Hospital, Winnipeg, Manitoba, Canada. Electronic address: Gregory.Hansen@umanitoba.ca.
authors.forename: Gregory
authors.initials: G
authors.lastname: Hansen
authors.affiliation: Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada.
authors.forename: Jeff K
authors.initials: JK
authors.lastname: Vallance
authors.affiliation: Section of Pediatric Emergency, Department of Pediatrics and Child Health, University of Manitoba, Children's Hospital, Winnipeg, Manitoba, Canada.
authors.forename: Darcy L
authors.initials: DL
authors.lastname: Beer
authors.affiliation: Department of Ophthalmology, Faculty of Medicine, University of Manitoba, Children's Hospital, Winnipeg, Manitoba, Canada.
authors.forename: Ian
authors.initials: I
authors.lastname: Clark
authors.affiliation: Section of Pediatric Endocrinology, Department of Pediatrics and Child Health, University of Manitoba, Children's Hospital, Winnipeg, Manitoba, Canada.
authors.forename: Elizabeth A C
authors.initials: EAC
authors.lastname: Sellers
mesh_terms: D000293:Adolescent; D002648:Child; D016883:Diabetic Ketoacidosis / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D006801:Humans; D019586:Intracranial Hypertension / Q000175:diagnosis*; D008297:Male; D009900:Optic Nerve / Q000000981:diagnostic imaging* / Q000473:pathology; D010865:Pilot Projects; D015203:Reproducibility of Results; D014463:Ultrasonography
keywords: Cerebral edema; Diabetic ketoacidosis; Elevated intracranial pressure; Optic nerve sheath diameter; Pediatric; Ultrasonography