Diabetic ketoacidosis and electroencephalographic changes in newly diagnosed pediatric patients

Mackay, Mark T., Molesworth, Charlotte., Northam, Elisabeth A., Inder, Terrie E., Cameron, Fergus J., Alexopoulos, J., Ditchfield, M.R., Finney, K., Jennings, J.E., Kean, M., Knight, S.J., Koves, I.H., Lee, K.J., Lin, A., Nadebaum, C., Neil, J.J., Scratch, S.E., Spencer-Smith, M., Wellard, R. Mark, & Werther, G.A. (2016) Diabetic ketoacidosis and electroencephalographic changes in newly diagnosed pediatric patients. Pediatric Diabetes, 17(4), pp. 244-248.

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Abstract

Objective: To document electroencephalogram (EEG) changes and their correlation with clinical parameters in a newly diagnosed pediatric cohort of type 1 diabetes mellitus (T1DM) patients with and without diabetic ketoacidosis (DKA) and to define their medium term utility and significance.

Research design and methods: Prospective longitudinal study of children presenting with T1DM. EEGs were performed within 24 h of diagnosis, day 5, and at 6 months post-diagnosis and reviewed by a neurologist blinded to clinical status. Severity of encephalopathy was graded from 1 to 5 using the Aoki and Lombroso encephalopathy scale. Cognitive abilities were assessed using standardized tests of attention, memory, and intelligence.

Results: Eighty eight children were recruited; 34 presented with DKA. Abnormal background slowing was more often observed in the first 24 h in children with DKA (p = 0.01). Encephalopathy scores on day 1 correlated with initial pH, CO2, HCO3, base excess, respiratory rate, heart rate, diastolic blood pressure, and IV fluid intake (all parameters p < 0.05). EEG scores at day 1 did not correlate with contemporaneous mental state or cognition in the medium term.

Conclusions: DKA was associated with significant clinical and neurophysiologic signs of brain dysfunction at presentation. While EEG is sensitive to the detection of encephalopathy in newly diagnosed T1DM, it has limited use in identifying children at risk of later cognitive deficits.

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ID Code: 94108
Item Type: Journal Article
Refereed: Yes
Keywords: DKA Brain Injury Study Group, Brain, DKA, EEG
DOI: 10.1111/pedi.12284
ISSN: 1399-5448
Subjects: Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > CLINICAL SCIENCES (110300)
Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > CLINICAL SCIENCES (110300) > Endocrinology (110306)
Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > NEUROSCIENCES (110900) > Central Nervous System (110903)
Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > PAEDIATRICS AND REPRODUCTIVE MEDICINE (111400) > Paediatrics (111403)
Divisions: Current > Schools > School of Chemistry, Physics & Mechanical Engineering
Current > Institutes > Institute of Health and Biomedical Innovation
Current > QUT Faculties and Divisions > Science & Engineering Faculty
Funding:
Copyright Owner: Copyright 2015 John Wiley & Sons A/S
Deposited On: 22 Mar 2016 02:41
Last Modified: 26 May 2016 00:25

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