Cerebral Hyperemia Measured with Near Infrared Spectroscopy during Treatment of Diabetic Ketoacidosis in Children

Objective To use near infrared spectroscopy (NIRS) to evaluate the timing of onset and duration of cerebral hyperemia during diabetic ketoacidosis (DKA) treatment in children, and to investigate the relationship of cerebral hyperemia to intravenous fluid treatment. Study design We randomized children aged 8-18 years with DKA to either more rapid or slower intravenous fluid treatment (19 total DKA episodes). NIRS was used to measure rSO(2) during DKA treatment. NIRS monitoring began as soon as informed consent was obtained and continued until the patient was transferred out of the critical care unit. Results rSO(2) values above the normal range (>80%) were detected in 17 of 19 DKA episodes (mean rSO(2) during initial 8 hours of DKA treatment: 86% +/- 7%, range 65%-95%). Elevated rSO(2) values were detected as early as the second hour of DKA treatment and persisted for as long as 27 hours. Hourly mean rSO(2) levels during treatment did not differ significantly by fluid treatment group. Conclusions During DKA treatment, children have elevated rSO(2) values consistent with cerebral hyperemia. Hyperemia occurs as early as the second hour of DKA treatment and may persist for >= 27 hours. Cerebral rSO(2) levels during treatment did not differ significantly in patients treated with slower versus more rapid intravenous rehydration.