CEREBRAL EDEMA IN PEDIATRIC DIABETIC KETOACIDOSIS

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This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Diabetic ketoacidosis (DKA) is a life threatening condition characterized by hypoglycemia, acidosis and ketonuria in children with Type I Diabetes Mellitus (IDDM). The most serious complication is brain swelling leading to brain herniation and death. Currently, both the pathophysiology that underlies the progressive sequence leading to fulminant cerebral edema are unknown. We plan to study DKA patients in hopes of better understanding the the pathophysiology of the disease. We will employ 3 established techniques to study the cerebral changes that occur in pediatric DKA: 1) MRI, 2) Near Infrared Spectroscopy (NIRS) and 3) Transcranial Doppler; all are used in clinical practice. While it will be used only for research purposes in this study (cases only), MRI is a standard diagnostic tool used to diagnose cerebral edema, cerebral ischemia and cerebral hyperemia. NIRS is a method of assessing cerebral oxygenation non-invasively. This technique passes near-infrared light through the patient's forehead and cerebral cortex. A study of 5 patients with DKA suggest that cerebral vasodilatation and hyperemia occur in DKA. This will be a prospective, observational, single site, 2 year study at CHRMC of children 17 years with IDDM who receive medical care at CHRMC. For all 3 specific aims, cases will be 51 patients admitted with IDDM and either critical or severe DKA. For all 3 specific aims, controls will be 51 children 17 years with IDDM without DKA who receive their routine medical care at the CHRMC endocrinology clinic. Overall, this will involve 102 patients.