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Cranial CT in children and adolescents with diabetic ketoacidosis
W H Hoffman1, C M Steinhart, T el Gammal
1Department of Pediatrics, Medical College of Georgia, Augusta 30912.
Insights
Diabetic ketoacidosis can cause cerebral swelling, which is evident even before treatment begins. Brain imaging in children showed reduced ventricle size on admission and after initial treatment, indicating swelling is present early.
Area of Science:
- Neurology
- Pediatrics
- Endocrinology
Background:
- Diabetic ketoacidosis (DKA) is a serious complication of diabetes.
- Cerebral edema is a known risk in DKA, but its timing is not fully understood.
Purpose of the Study:
- To investigate the presence and timing of cerebral swelling in pediatric patients with DKA.
Main Methods:
- Cranial CT scans were performed on nine pediatric patients (ages 6-17) with DKA.
- Scans were taken on admission, 6-8 hours after treatment initiation, and 7 days after admission.
Main Results:
- Significantly reduced lateral and third ventricle size was observed on pretreatment scans and at 6-8 hours post-treatment compared to 7-day scans.
- No significant difference in ventricle size was found between pretreatment scans and those at 6-8 hours post-treatment.
Conclusions:
- Cerebral swelling associated with DKA is typically present before treatment begins.
- Early treatment does not appear to rapidly reverse the observed cerebral swelling.
Abstract:
To determine the effects of diabetic ketoacidosis on the brain, we studied nine consecutive patients between the ages of 6 and 17 years by performing cranial CT on three occasions: on admission, before treatment; 6-8 hr after beginning treatment; and 7 days after admission. Both the pretreatment scans and those at 6-8 hr showed significantly reduced size of the lateral and third ventricles in comparison with the 7-day scans. A comparison of the pretreatment scans with those done at 6-8 hr showed no statistically significant differences. We conclude that the cerebral swelling of diabetic ketoacidosis is usually present before treatment.