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Subclinical cerebral edema in children with diabetic ketoacidosis randomized to 2 different rehydration protocols

Nicole S Glaser1, Sandra L Wootton-Gorges, Michael H Buonocore

  • 1Department of Pediatrics, School of Medicine, University of California Davis, Davis, California, USA. nsglaser@ucdavis.edu

Pediatrics
|December 12, 2012
PubMed

Insights

Intravenous fluid rates do not significantly impact vasogenic cerebral edema (CE) during diabetic ketoacidosis (DKA) treatment in children. This study quantified subclinical CE using MRI, finding no substantial difference between rapid and slow fluid administration rates.

Area of Science:

  • Pediatric Endocrinology
  • Neuroimaging
  • Critical Care Medicine

Background:

  • Diabetic ketoacidosis (DKA) in children can lead to vasogenic cerebral edema (CE).
  • The influence of intravenous fluid administration rates on CE during DKA treatment remains unclear.
  • Quantifying subclinical CE is crucial for understanding DKA treatment complications.

Purpose of the Study:

  • To investigate the role of intravenous fluid rates in the development of subclinical vasogenic cerebral edema (CE) during diabetic ketoacidosis (DKA) treatment in children.
  • To utilize magnetic resonance diffusion-weighted imaging to measure CE non-invasively.
  • To compare CE severity in children receiving DKA treatment with different intravenous fluid infusion rates.

Main Methods:

  • Children with DKA were randomized into two groups receiving intravenous fluids at either a rapid or slower rate.
  • Diffusion-weighted imaging (DWI) was performed during DKA treatment (3-6 and 9-12 hours) and after recovery (≥72 hours).
  • Apparent diffusion coefficient (ADC) values were calculated to quantify brain water content and assess CE severity.

Main Results:

  • Mean brain ADC values were significantly higher during DKA treatment compared to post-recovery, confirming vasogenic CE.
  • No significant differences in ADC elevation were observed between children receiving rapid versus slower intravenous fluid rates.
  • The rate of fluid administration did not substantially influence the degree of subclinical CE.

Conclusions:

  • The rate of intravenous fluid administration does not appear to be a major factor in the development of vasogenic cerebral edema during DKA treatment in children.
  • Subclinical CE, indicated by ADC changes, occurs during DKA treatment.
  • Further research may explore other contributing factors to CE in DKA.
Abstract

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