Cerebral Edema in Pediatric Diabetic Ketoacidosis

描述（由申请人提供）：每年有近22,000名儿童因胰岛素依赖型糖尿病（IDDM）并发症住院。糖尿病酮症酸中毒（DKA）是一种危及生命的疾病，是IDDM相关入院的头号原因。脑水肿发生在儿童DKA发作的1-3%，占DKA死亡的30 - 90%。虽然一些研究记录了DKA患儿脑水肿，但脑水肿的原因尚不清楚。由于缺乏对脑水肿病理生理学的了解，IDDM患儿面临死亡或永久性残疾的风险，而卫生保健提供者也缺乏预防这一并发症的必要知识。流行病学数据表明，儿童DKA患者脑缺血和脑水肿之间存在关联。然而，有限的临床研究证明脑充血而不是脑缺血。因此，本研究的总体目标是表征DKA危重症患儿的脑血管变化，并确定实验室标志物、脑血管变化与脑水肿有无之间的关系。为此，我们提出了三个具体目标：1)检查危重DKA患儿脑充血和脑水肿之间的关系；2)确定危重DKA患儿脑自动调节受损的发生率；3)探索危重DKA患儿脑充血和脑水肿与潜在临床和实验室预测因子之间的关系。本研究结果将有助于：1)加深对DKA相关脑水肿病理生理学的理解；2)创新使用现有方法来检查儿童DKA的脑血管变化（新科学领域），并最终通过进一步研究；3)开发临床有用的评分系统和筛查程序来识别脑水肿风险儿童；4)确定预防脑水肿所需的管理策略。

DESCRIPTION (provided by applicant): Nearly 22,000 children are hospitalized annually for complications of insulin dependent diabetes mellitus (IDDM). Diabetic ketoacidosis (DKA) is a life threatening condition and is the number one reason for IDDM related admissions. Cerebral edema occurs in 1-3% of pediatric DKA episodes and accounts for 30 - 90% of DKA deaths. Although several studies document cerebral edema in children with DKA, the cause of cerebral edema is unknown. The lack of understanding of the pathophysiology of cerebral edema leaves children with IDDM at risk for death or permanent disability, and health care providers without the necessary knowledge to prevent this complication. Epidemiologic data suggest an association between cerebral ischemia and cerebral edema in pediatric DKA. However, limited clinical studies document cerebral hyperemia NOT cerebral ischemia. Therefore, the overall goals of this study are to characterize cerebrovascular changes in children critically ill with DKA, and to determine the relationship between laboratory markers, cerebrovascular changes and the presence or absence of cerebral edema.To do this, we propose three specific aims: 1)To examine the relationship between cerebral hyperemia and cerebral edema in children with critical and severe DKA, 2) To determine the incidence of impaired cerebral autoregulation in critical and severe DKA and 3) To explore the relationship between potential clinical and laboratory predictors and cerebral hyperemia and cerebral edema in critical and severe DKA. The findings of this study will lead to: 1) a greater understanding of the pathophysiology of DKA related cerebral edema, 2) the innovative use of existing methodologies to examine cerebrovascular changes in pediatric DKA (new scientific area), and ultimately through further study, 3) the development of a clinically useful scoring system and screening program that identifies children at risk for cerebral edema, and 4) the identification of management strategies needed to prevent cerebral edema.