Conscious level in children with diabetic ketoacidosis is related to severity of acidosis and not to blood glucose concentration

Pediatric Diabetes

Volumn 7, Issue 1, 2006, Pages 11-15

  Edge, Julie A ^a   Roy, Yvonne ^a   Bergomi, Andrea ^b   Murphy, Nuala P ^a   Ford Adams, Martha E ^a   Ong, Ken K ^c   Dunger, David B ^c  

^a JOHN RADCLIFFE HOSPITAL   (United Kingdom)

^b Pavullo Hospital   (Italy)

^c UNIVERSITY OF CAMBRIDGE   (United Kingdom)

Author keywords

Acidosis; BG; Ketoacidosis; Level of consciousness

Indexed keywords

ELECTROLYTE; GLUCOSE; SODIUM ION;

ACIDOSIS; ADOLESCENT; AGE; AGITATION; ALERTNESS; ANALYSIS OF VARIANCE; ARTICLE; BLOOD CHEMISTRY; BLOOD PH; BRAIN EDEMA; BRAIN FUNCTION; CHILD; COMA; CONFUSION; CONSCIOUSNESS DISORDER; CONSCIOUSNESS LEVEL; CONTROLLED STUDY; CORRELATION ANALYSIS; DIABETIC KETOACIDOSIS; DISEASE ASSOCIATION; DISEASE SEVERITY; DROWSINESS; ELECTROLYTE BLOOD LEVEL; FEMALE; GLASGOW COMA SCALE; GLUCOSE BLOOD LEVEL; HUMAN; HYPEROSMOLALITY; MAJOR CLINICAL STUDY; MALE; MULTIVARIATE ANALYSIS; ORIENTATION; PLASMA OSMOLALITY; PRIORITY JOURNAL; SODIUM BLOOD LEVEL; UNIVARIATE ANALYSIS;

ADOLESCENT; AGE FACTORS; BLOOD GLUCOSE; BRAIN EDEMA; CHILD; CHILD, PRESCHOOL; CONSCIOUSNESS; DIABETES MELLITUS, TYPE 1; DIABETIC KETOACIDOSIS; FEMALE; HUMANS; HYDROGEN-ION CONCENTRATION; INFANT; MALE; MULTIVARIATE ANALYSIS; OSMOLAR CONCENTRATION; SODIUM BICARBONATE; UNCONSCIOUSNESS;

EID: 33646709177     PISSN: 1399543X     EISSN: 13995448     Source Type: Journal    
DOI: 10.1111/j.1399-543X.2006.00143.x     Document Type: Article

References (24)

1. Alberti KGMM, Nattrass M. Severe diabetic ketoacidosis. Med Clin North Am 1978: 62: 799-814.
2. Ruderman NB, G oodman MN. Brain metabolism in diabetes. Horm Metab Res 1980: 9: 1-8.
3. Rosival V. The influence of blood hydrogen ion concentration on the level of consciousness in diabetic ketoacidosis. Ann Clin Res 1987: 19: 23-25.
4. Fulop M, Rosenblatt A, Kreitzer SM, Gerstenhaber B. Hyperosmolar nature of diabetic coma. Diabetes 1975: 24: 594-599.
5. Edge JA, Hawkins MM, Winter DL, Dunger DB. The risk and outcome of cerebral oedema developing during diabetic ketoacidosis. Arch Dis Child 2001: 85: 16-20.
6. Harris GA, Fiordalisi I. Physiologic management of diabetic ketoacidemia. A 5-year prospective pediatric experience in 231 episodes. Arch Pediatr Adolesc Med 1994: 48: 1046-1052.
7. Glaser N, Barnett P, Mc Caslin I et al. Risk factors for cerebral edema in children with diabetic ketoacidosis. N Engl J Med 2001: 344: 264-269.
8. Reilly P, Simpson O, Sprod R, Thomas L. Assessing the conscious level in infants and young children: A pediatric version of Glasgow Coma Scale. Childs Nerv Syst 1988: 4: 30-33.
9. Fisher P. The role of ketone bodies in the etiology of diabetic coma. Diabetes 1952: 1: 108-111.
10. Guisado R, Arieff AI. Neurologic manifestations of diabetic comas: correlation with biochemical alterations in the brain. Metabolism 1975: 24: 665-679.
11. Thio LL, Wong M, Yamada KA. Ketone bodies do not directly alter excitatory or inhibitory hippocampal synaptic transmission. Neurology 2000: 54: 325-331.
12. Glaser NS, Wootton-Gorges SL, Marcin JP et al. Mechanism of cerebral edema in children with diabetic ketoacidosis. J Pediatr 2004: 145: 164-171.
13. Kuschinsky W, Suda S, Sokoloff L. Local cerebral glucose utilisation and blood flow during metabolic acidosis. Am J Physiol 1981: 241: H772-H777.
14. 2 in anesthetized chronically diabetic dogs. Am J Physiol 1993: 264: H1069-H1075.
15. Munro JF, Campbell IW, Mc Cuish AC, Duncan LJP. Euglycaemic diabetic ketoacidosis. Br Med J 1973: 2: 278-580.
16. Malchoff CD, Pohl SL, Kaiser DL, Carey RM. Determinants of glucose and ketoacid concentrations in acutely hyperglycaemic diabetic patients. Am J Med 1984: 77:275-285.
17. Jenkins D, Close CF, Krentz AJ, Nattrass M, Wright AD. Euglycemic diabetic ketoacidosis: Does it exist? Acta Diabetol 1993: 30: 251-253.
18. Brandt KR, Miles JM. Relationship between severity of hyperglycemia and metabolic acidosis and diabetic ketoacidosis. Mayo Clin Proc 1998: 63: 1071-1074.
19. Miles JM, Rizza RA, Haymond MW, Gerich JE. Effects of acute insulin deficiency on glucose and ketone body turnover in man: Evidence for the primacy of over-production of glucose and ketone bodies in the genesis of diabetic ketoacidosis. Diabetes 1980: 29: 926-930.
20. Burge MR, Garcia N, Qualls CR, Schade DS. Differential effects of fasting and dehydration in the pathogenesis of diabetic ketoacidosis. Metabolism 2001: 50: 171-177.
21. Dunger DB, Sperling MA, Acerini CL et al. European Society for Paediatric Endocrinology/Lawson Wilkins Pediatric Endocrine Society consensus statement on diabetic ketoacidosis in children and Eadolescents. Pediatrics 2004: 113: e133-e140.
22. Rosenbloom AL. Intracerebral crises during treatment of diabetic ketoacidosis. Diabetes Care 1990: 13: 22-33.
23. Krane EJ, Rockoff MA, Wallman JK, Wolfsdorf JI. Subclinical brain swelling in children during treatment of diabetic ketoacidosis. N Engl J Med 1985: 312: 1147-1151.
24. Hoffman WH, Steinhart CM, El Gammal T, Steele S, Cuadrado AR, Morse PL. Cranial CT in children and adolescents with diabetic ketoacidosis. Am J Neuroradiol 1988: 9: 733-739.