Diabetic ketoacidosis and electroencephalographic changes in newly diagnosed pediatric patients
Mark T Mackay1, Charlotte Molesworth2, Elisabeth A Northam3,4
1Department of Neurology, Royal Children's Hospital, Melbourne, Victoria, Australia.
Insights
Electroencephalogram (EEG) changes in children with new-onset type 1 diabetes mellitus (T1DM) and diabetic ketoacidosis (DKA) show brain dysfunction at diagnosis. However, EEG findings at diagnosis do not predict long-term cognitive deficits.
Area of Science:
- Pediatric Neurology
- Endocrinology
- Neurophysiology
Background:
- Type 1 diabetes mellitus (T1DM) is an autoimmune disease affecting children.
- Diabetic ketoacidosis (DKA) is a serious complication of T1DM.
- Brain dysfunction can occur in pediatric T1DM, particularly with DKA.
Purpose of the Study:
- To document electroencephalogram (EEG) changes in newly diagnosed pediatric T1DM patients.
- To correlate EEG findings with clinical parameters, especially in the presence of DKA.
- To assess the medium-term utility of EEG in predicting cognitive outcomes.
Main Methods:
- A prospective longitudinal study of 88 children with new-onset T1DM.
- EEG recordings were performed at diagnosis, day 5, and 6 months post-diagnosis.
- Clinical parameters and cognitive abilities were assessed, and encephalopathy was graded.
Main Results:
- Abnormal EEG background slowing was more frequent in children with DKA at diagnosis (p=0.01).
- EEG encephalopathy scores correlated with initial metabolic and hemodynamic parameters.
- EEG scores at diagnosis did not correlate with medium-term cognitive function.
Conclusions:
- DKA is associated with significant neurophysiological signs of brain dysfunction in pediatric T1DM at presentation.
- EEG is sensitive for detecting encephalopathy in new-onset T1DM.
- EEG has limited value in identifying children at risk for later cognitive deficits.
Objective:
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.
Research Design And Methods:
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.
Results:
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.
Conclusions:
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.
More Related Videos
11:54Simultaneous Video-EEG-ECG Monitoring to Identify Neurocardiac Dysfunction in Mouse Models of Epilepsy
Published on: January 29, 2018
09:57Author Spotlight: Advancing Pediatric Epilepsy Surgery in Children Through Novel Biomarkers and Enhanced Localization
Published on: September 20, 2024
Related Concept Videos
01:24Diagnosing Acidosis and Alkalosis
First, the pH level is assessed to determine whether the blood pH is normal (7.35–7.45), low (acidosis), or high (alkalosis).
Next, the PCO2 and...
01:24Pharmacokinetics in Pediatric Patients: Drug Metabolism
01:24Epilepsy and Seizures: Overview
Various factors can trigger epilepsy, including genetic factors, brain damage, metabolic causes, and unknown etiology. Diagnosis of epilepsy involves electroencephalography (EEG), which...