Optic Nerve Sheath Diameter Ultrasonography in Pediatric Patients with Diabetic Ketoacidosis
Abstract Objectives Subclinical cerebral edema has been reported in pediatric patients with type 1 diabetes and diabetic ketoacidosis (DKA) through magnetic resonance imaging. Ultrasonography of the optic nerve sheath diameter (ONSD) has been used to evaluate intracranial pressure. The objective of...
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Published in | Canadian journal of diabetes Vol. 40; no. 2; pp. 126 - 130 |
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Main Authors | , , , , |
Format | Journal Article |
Language | English |
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Elsevier Inc
01.04.2016
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Abstract | Abstract Objectives Subclinical cerebral edema has been reported in pediatric patients with type 1 diabetes and diabetic ketoacidosis (DKA) through magnetic resonance imaging. Ultrasonography of the optic nerve sheath diameter (ONSD) has been used to evaluate intracranial pressure. The objective of this study was to examine the utility of ONSD ultrasonography to evaluate intracranial pressures in children with DKA. Methods This prospective cohort evaluated pediatric patients who presented to the emergency department of the Children's Hospital at the University of Manitoba with DKA within 3 hours of initial treatment. A pediatric bedside neurologic evaluation tool for cerebral edema was utilized 1) within the first hour of the intravenous fluid initiation (t=0 hr); 2) 8 hours after initiation of treatment (t=8 hr); and 3) at hours after presentation (t=24 hr). At each time interval, 3 images of the patients' ONSDs were scanned by an 11 MHz linear array transducer. Increased intracranial pressure was considered in all patients whose mean ONSDs were >4.5 mm. Results We evaluated 7 patients, aged 4 to 17 years. No patients were clinically assessed as having cerebral edema. Overall, no significant differences emerged among the 3 time points (t=0 vs. t=8 hr; t=0 vs. t=24 hr; t=8 vs. t=24 hr) (all p>.216). Effect sizes were small at 0.14 (t=0 vs. t=8 hr); 0.27 (t=8 vs. t=24 hr); and 0.07 (t=0 vs. t=24). Conclusions Although not statistically significant, subtle changes in intracranial pressure may have been detected with ONSD ultrasonography in pediatric patients with DKA. |
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AbstractList | Subclinical cerebral edema has been reported in pediatric patients with type 1 diabetes and diabetic ketoacidosis (DKA) through magnetic resonance imaging. Ultrasonography of the optic nerve sheath diameter (ONSD) has been used to evaluate intracranial pressure. The objective of this study was to examine the utility of ONSD ultrasonography to evaluate intracranial pressures in children with DKA.
This prospective cohort evaluated pediatric patients who presented to the emergency department of the Children's Hospital at the University of Manitoba with DKA within 3 hours of initial treatment. A pediatric bedside neurologic evaluation tool for cerebral edema was utilized 1) within the first hour of the intravenous fluid initiation (t=0 hr); 2) 8 hours after initiation of treatment (t=8 hr); and 3) at hours after presentation (t=24 hr). At each time interval, 3 images of the patients' ONSDs were scanned by an 11 MHz linear array transducer. Increased intracranial pressure was considered in all patients whose mean ONSDs were >4.5 mm.
We evaluated 7 patients, aged 4 to 17 years. No patients were clinically assessed as having cerebral edema. Overall, no significant differences emerged among the 3 time points (t=0 vs. t=8 hr; t=0 vs. t=24 hr; t=8 vs. t=24 hr) (all p>.216). Effect sizes were small at 0.14 (t=0 vs. t=8 hr); 0.27 (t=8 vs. t=24 hr); and 0.07 (t=0 vs. t=24).
Although not statistically significant, subtle changes in intracranial pressure may have been detected with ONSD ultrasonography in pediatric patients with DKA. Abstract Objectives Subclinical cerebral edema has been reported in pediatric patients with type 1 diabetes and diabetic ketoacidosis (DKA) through magnetic resonance imaging. Ultrasonography of the optic nerve sheath diameter (ONSD) has been used to evaluate intracranial pressure. The objective of this study was to examine the utility of ONSD ultrasonography to evaluate intracranial pressures in children with DKA. Methods This prospective cohort evaluated pediatric patients who presented to the emergency department of the Children's Hospital at the University of Manitoba with DKA within 3 hours of initial treatment. A pediatric bedside neurologic evaluation tool for cerebral edema was utilized 1) within the first hour of the intravenous fluid initiation (t=0 hr); 2) 8 hours after initiation of treatment (t=8 hr); and 3) at hours after presentation (t=24 hr). At each time interval, 3 images of the patients' ONSDs were scanned by an 11 MHz linear array transducer. Increased intracranial pressure was considered in all patients whose mean ONSDs were >4.5 mm. Results We evaluated 7 patients, aged 4 to 17 years. No patients were clinically assessed as having cerebral edema. Overall, no significant differences emerged among the 3 time points (t=0 vs. t=8 hr; t=0 vs. t=24 hr; t=8 vs. t=24 hr) (all p>.216). Effect sizes were small at 0.14 (t=0 vs. t=8 hr); 0.27 (t=8 vs. t=24 hr); and 0.07 (t=0 vs. t=24). Conclusions Although not statistically significant, subtle changes in intracranial pressure may have been detected with ONSD ultrasonography in pediatric patients with DKA. Subclinical cerebral edema has been reported in pediatric patients with type 1 diabetes and diabetic ketoacidosis (DKA) through magnetic resonance imaging. Ultrasonography of the optic nerve sheath diameter (ONSD) has been used to evaluate intracranial pressure. The objective of this study was to examine the utility of ONSD ultrasonography to evaluate intracranial pressures in children with DKA. This prospective cohort evaluated pediatric patients who presented to the emergency department of the Children's Hospital at the University of Manitoba with DKA within 3 hours of initial treatment. A pediatric bedside neurologic evaluation tool for cerebral edema was utilized 1) within the first hour of the intravenous fluid initiation (t=0 hr); 2) 8 hours after initiation of treatment (t=8 hr); and 3) at hours after presentation (t=24 hr). At each time interval, 3 images of the patients' ONSDs were scanned by an 11 MHz linear array transducer. Increased intracranial pressure was considered in all patients whose mean ONSDs were >4.5 mm. We evaluated 7 patients, aged 4 to 17 years. No patients were clinically assessed as having cerebral edema. Overall, no significant differences emerged among the 3 time points (t=0 vs. t=8 hr; t=0 vs. t=24 hr; t=8 vs. t=24 hr) (all p>.216). Effect sizes were small at 0.14 (t=0 vs. t=8 hr); 0.27 (t=8 vs. t=24 hr); and 0.07 (t=0 vs. t=24). Although not statistically significant, subtle changes in intracranial pressure may have been detected with ONSD ultrasonography in pediatric patients with DKA. L'œdème cérébral subclinique a été rapporté chez les patients de pédiatrie souffrant du diabète de type 1 et d'acidocétose diabétique (ACD) par l'imagerie par résonance magnétique. L'ultrasonographie du diamètre de la gaine du nerf optique (DGNO) a été utilisée pour évaluer la pression intracrânienne. L'objectif de cette étude était d'examiner l'utilité de l'ultrasonographie du DGNO pour évaluer les pressions intracrâniennes chez les enfants souffrant d'ACD. Cette cohorte prospective évaluait les patients de pédiatrie qui se présentaient au service des urgences de l'Hôpital pour enfants de l'Université du Manitoba en raison d'une ACD au cours des 3 heures suivant le traitement initial. Un outil d'évaluation neuropédiatrique de l'œdème cérébral au chevet du patient était utilisé 1) au cours de la première heure après l'administration d'un liquide par voie intraveineuse (t=0 h); 2) 8 heures après le début du traitement (t=8 h); 3) dans les heures après l'arrivée (t=24 h). À chaque intervalle de temps, 3 images des DGNO des patients étaient balayées par une sonde linéaire de 11 MHz. L'augmentation de la pression intracrânienne était considérée chez tous les patients dont la moyenne du DGNO était>4.5 mm. Nous avons évalué 7 patients âgés de 4 à 17 ans. Aucun patient n'était cliniquement évalué comme souffrant d'un œdème cérébral. Dans l'ensemble, aucune différence significative n'est apparue entre les 3 moments temporels (t=0 vs t=8 h; t=0 vs t=24 h; t=8 vs t=24 h) (tous p>0.216). Les petites tailles de l'effet se situaient à 0.14 (t=0 vs t=8 h); 0,27 (t=8 vs t=24 h); 0,07 (t=0 vs t=24). Bien que non significatifs sur le plan statistique, les changements subtils de la pression intracrânienne pouvaient être détectés à l'ultrasonographie du DGNO chez les patients de pédiatrie souffrant d'ACD. OBJECTIVESSubclinical cerebral edema has been reported in pediatric patients with type 1 diabetes and diabetic ketoacidosis (DKA) through magnetic resonance imaging. Ultrasonography of the optic nerve sheath diameter (ONSD) has been used to evaluate intracranial pressure. The objective of this study was to examine the utility of ONSD ultrasonography to evaluate intracranial pressures in children with DKA.METHODSThis prospective cohort evaluated pediatric patients who presented to the emergency department of the Children's Hospital at the University of Manitoba with DKA within 3 hours of initial treatment. A pediatric bedside neurologic evaluation tool for cerebral edema was utilized 1) within the first hour of the intravenous fluid initiation (t=0 hr); 2) 8 hours after initiation of treatment (t=8 hr); and 3) at hours after presentation (t=24 hr). At each time interval, 3 images of the patients' ONSDs were scanned by an 11 MHz linear array transducer. Increased intracranial pressure was considered in all patients whose mean ONSDs were >4.5 mm.RESULTSWe evaluated 7 patients, aged 4 to 17 years. No patients were clinically assessed as having cerebral edema. Overall, no significant differences emerged among the 3 time points (t=0 vs. t=8 hr; t=0 vs. t=24 hr; t=8 vs. t=24 hr) (all p>.216). Effect sizes were small at 0.14 (t=0 vs. t=8 hr); 0.27 (t=8 vs. t=24 hr); and 0.07 (t=0 vs. t=24).CONCLUSIONSAlthough not statistically significant, subtle changes in intracranial pressure may have been detected with ONSD ultrasonography in pediatric patients with DKA. |
Author | Clark, Ian, MA, MB, BChir, FRCSEd (Ophth) Hansen, Gregory, MD, FRCP(C), MSc, MPH Sellers, Elizabeth A.C., MD, FRCP(C), MSc Vallance, Jeff K., PhD Beer, Darcy L., MD, FRCP(C) |
Author_xml | – sequence: 1 fullname: Hansen, Gregory, MD, FRCP(C), MSc, MPH – sequence: 2 fullname: Sellers, Elizabeth A.C., MD, FRCP(C), MSc – sequence: 3 fullname: Beer, Darcy L., MD, FRCP(C) – sequence: 4 fullname: Vallance, Jeff K., PhD – sequence: 5 fullname: Clark, Ian, MA, MB, BChir, FRCSEd (Ophth) |
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CitedBy_id | crossref_primary_10_1159_000497163 crossref_primary_10_1055_s_0040_1716385 crossref_primary_10_1111_pedi_13188 crossref_primary_10_1177_1024907919892161 crossref_primary_10_1007_s00592_018_1242_8 crossref_primary_10_1016_j_earlhumdev_2020_104986 crossref_primary_10_1097_MOP_0000000000000689 crossref_primary_10_1016_j_jdiacomp_2016_07_010 crossref_primary_10_1186_s12871_016_0267_1 crossref_primary_10_1177_02841851231169176 crossref_primary_10_3390_diagnostics12030767 crossref_primary_10_1177_0284185120966715 crossref_primary_10_1515_jpem_2019_0016 crossref_primary_10_1515_jpem_2019_0440 crossref_primary_10_3390_diagnostics13030535 |
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Keywords | Pédiatrique Acidocétose diabétique Diabetic ketoacidosis Ultrasonography Diamètre de la gaine du nerf optique Œdème cérébral Ultrasonographie Cerebral edema Pediatric Optic nerve sheath diameter |
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Snippet | Abstract Objectives Subclinical cerebral edema has been reported in pediatric patients with type 1 diabetes and diabetic ketoacidosis (DKA) through magnetic... Subclinical cerebral edema has been reported in pediatric patients with type 1 diabetes and diabetic ketoacidosis (DKA) through magnetic resonance imaging.... OBJECTIVESSubclinical cerebral edema has been reported in pediatric patients with type 1 diabetes and diabetic ketoacidosis (DKA) through magnetic resonance... |
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SubjectTerms | Acidocétose diabétique Adolescent Cerebral edema Child Child, Preschool Diabetes Mellitus, Type 1 - complications Diabetes Mellitus, Type 1 - diagnostic imaging Diabetes Mellitus, Type 1 - pathology Diabetic ketoacidosis Diabetic Ketoacidosis - diagnostic imaging Diabetic Ketoacidosis - etiology Diabetic Ketoacidosis - pathology Diamètre de la gaine du nerf optique Emergency Service, Hospital Endocrinology & Metabolism Female Follow-Up Studies Humans Intracranial Hypertension - diagnostic imaging Male Optic Nerve - diagnostic imaging Optic Nerve - pathology Optic nerve sheath diameter Other Pediatric Pilot Projects Prognosis Prospective Studies Pédiatrique Ultrasonographie Ultrasonography Ultrasonography - methods Œdème cérébral |
Title | Optic Nerve Sheath Diameter Ultrasonography in Pediatric Patients with Diabetic Ketoacidosis |
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