Cerebral Hyperemia Measured with Near Infrared Spectroscopy during Treatment of Diabetic Ketoacidosis in Children

• Published in: The Journal of pediatrics Vol. 163; no. 4; pp. 1111 - 1116
• Main Authors: Glaser, Nicole S., MD, Tancredi, Daniel J., PhD, Marcin, James P., MD, MPH, Caltagirone, Ryan, MD, Lee, Yvonne, MD, Murphy, Christopher, BS, Kuppermann, Nathan, MD, MPH
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.10.2013
• Subjects: Adolescent; Brain - pathology; Cerebrovascular Circulation; Cerebrovascular Disorders - complications; Cerebrovascular Disorders - diagnosis; Cerebrovascular Disorders - pathology; Child; children; Diabetic Ketoacidosis - complications; Diabetic Ketoacidosis - pathology; Diabetic Ketoacidosis - therapy; Female; Fluid Therapy - methods; Humans; Hyperemia - complications; Hyperemia - diagnosis; Hyperemia - pathology; Infusions, Intravenous; intravenous injection; Linear Models; Male; monitoring; near-infrared spectroscopy; patients; Pediatrics; rehydration; Spectroscopy, Near-Infrared; Time Factors; Near infrared spectroscopy; Magnetic resonance imaging; Regional cerebral oxygen saturation; Cerebral blood flow; MRI; CBF; Diabetic ketoacidosis; NIRS; rS o 2; DKA; rSo2; rSo
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2013.06.008

Objective To use near infrared spectroscopy (NIRS) to evaluate the timing of onset and duration of cerebral hyperemia during diabetic ketoacidosis (DKA) treatment in children, and to investigate the relationship of cerebral hyperemia to intravenous fluid treatment. Study design We randomized children aged 8-18 years with DKA to either more rapid or slower intravenous fluid treatment (19 total DKA episodes). NIRS was used to measure rS o2 during DKA treatment. NIRS monitoring began as soon as informed consent was obtained and continued until the patient was transferred out of the critical care unit. Results rS o2 values above the normal range (>80%) were detected in 17 of 19 DKA episodes (mean rS o2 during initial 8 hours of DKA treatment: 86% ± 7%, range 65%-95%). Elevated rS o2 values were detected as early as the second hour of DKA treatment and persisted for as long as 27 hours. Hourly mean rS o2 levels during treatment did not differ significantly by fluid treatment group. Conclusions During DKA treatment, children have elevated rS o2 values consistent with cerebral hyperemia. Hyperemia occurs as early as the second hour of DKA treatment and may persist for ≥27 hours. Cerebral rS o2 levels during treatment did not differ significantly in patients treated with slower versus more rapid intravenous rehydration.