Clinical Characteristics of Children with Cerebral Injury preceding Treatment of Diabetic Ketoacidosis

Nicole S Glaser; Kimberly S Quayle; Julie K McManemy; Lise E Nigrovic; Leah Tzimenatos; Michael J Stoner; Jonathan E Bennett; Jennifer L Trainor; Arleta Rewers; Jeff E Schunk; Sage R Myers; Maria Y Kwok; Kathleen M Brown; Simona Ghetti; T Charles Casper; Cody S Olsen; Nathan Kuppermann; Pediatric Emergency Care Applied Research Network (PECARN) DKA FLUID Study Group

doi:10.1016/j.jpeds.2022.07.033

Clinical Characteristics of Children with Cerebral Injury preceding Treatment of Diabetic Ketoacidosis

J Pediatr. 2022 Nov:250:100-104. doi: 10.1016/j.jpeds.2022.07.033. Epub 2022 Aug 6.

Authors

Nicole S Glaser¹, Kimberly S Quayle², Julie K McManemy³, Lise E Nigrovic⁴, Leah Tzimenatos⁵, Michael J Stoner⁶, Jonathan E Bennett⁷, Jennifer L Trainor⁸, Arleta Rewers⁹, Jeff E Schunk¹⁰, Sage R Myers¹¹, Maria Y Kwok¹², Kathleen M Brown¹³, Simona Ghetti¹⁴, T Charles Casper¹⁰, Cody S Olsen¹⁰, Nathan Kuppermann¹⁵; Pediatric Emergency Care Applied Research Network (PECARN) DKA FLUID Study Group

Affiliations

¹ Department of Pediatrics, University of California Davis Health, University of California Davis School of Medicine, CA. Electronic address: nsglaser@ucdavis.edu.
² Division of Emergency Medicine, Department of Pediatrics, St Louis Children's Hospital, Washington University School of Medicine in St. Louis, St Louis, MO.
³ Division of Emergency Medicine, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX.
⁴ Division of Emergency Medicine, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA.
⁵ Department of Emergency Medicine, University of California Davis Health, University of California Davis School of Medicine, Sacramento, CA.
⁶ Division of Emergency Medicine, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University School of Medicine, Columbus, OH.
⁷ Division of Emergency Medicine, Nemours/AI DuPont Hospital for Children, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA.
⁸ Division of Emergency Medicine, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL.
⁹ Division of Emergency Medicine, Department of Pediatrics, The Colorado Children's Hospital, University of Colorado-Denver School of Medicine, Aurora, CO.
¹⁰ Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT.
¹¹ Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
¹² Division of Emergency Medicine, Department of Pediatrics, New York Presbyterian Morgan Stanley Children's Hospital, Columbia University College of Physicians and Surgeons, New York, NY.
¹³ Division of Emergency Medicine, Department of Pediatrics, Children's National Medical Center, The George Washington School of Medicine and Health Sciences, Washington, DC.
¹⁴ Department of Psychology, University of California Davis, Sacramento, CA.
¹⁵ Department of Pediatrics, University of California Davis Health, University of California Davis School of Medicine, CA; Department of Emergency Medicine, University of California Davis Health, University of California Davis School of Medicine, Sacramento, CA.

PMID: 35944716
DOI: 10.1016/j.jpeds.2022.07.033

Abstract

Previous studies have identified more severe acidosis and higher blood urea nitrogen (BUN) as risk factors for cerebral injury during treatment of diabetic ketoacidosis (DKA) in children; however, cerebral injury also can occur before DKA treatment. We found that lower pH and higher BUN levels also were associated with cerebral injury at presentation.

Publication types

Case Reports
Research Support, N.I.H., Extramural

MeSH terms

Blood Urea Nitrogen
Brain Injuries*
Child
Diabetes Mellitus*
Diabetic Ketoacidosis* / diagnosis
Diabetic Ketoacidosis* / therapy
Humans
Risk Factors