Cerebral Edema in Pediatric Diabetic Ketoacidosis

描述(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)并发症而住院。糖尿病酮症酸中毒(DKA)是一种威胁生命的疾病，也是IDDM相关住院的头号原因。脑水肿发生在1-3%的儿童DKA发作中，占DKA死亡的30%-90%。尽管有几项研究记录了DKA儿童的脑水肿，但脑水肿的原因尚不清楚。对脑水肿的病理生理学缺乏了解，使患有IDDM的儿童面临死亡或永久残疾的风险，卫生保健提供者没有必要的知识来预防这种并发症。流行病学数据表明，儿童DKA患者的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确定危重DKA患儿脑血管改变的特征，并确定实验室指标、脑血管变化与脑水肿的存在或不存在的关系。为此，我们提出三个具体目标：1)研究危重和重型DKA患儿脑充血和脑水肿的关系；2)确定危重和重型DKA患儿脑自我调节功能受损的发生率；3)探讨危重和重型DKA患者潜在的临床和实验室预测指标与脑充血和脑水肿的关系。这项研究的结果将导致：1)更好地了解DKA相关脑水肿的病理生理学；2)创新使用现有方法来检查儿童DKA(新的科学领域)的脑血管变化，并最终通过进一步的研究，3)开发临床上有用的评分系统和筛查计划，以识别有脑水肿风险的儿童，以及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.