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. 2010 May;11(3):332-8.
doi: 10.1097/PCC.0b013e3181c013f4.

Change in blood-brain barrier permeability during pediatric diabetic ketoacidosis treatment

Monica S Vavilala  1 , Todd L Richards, Joan S Roberts, Harvey Chiu, Catherine Pihoker, Heidi Bradford, Kristina Deeter, Ken I Marro, Dennis Shaw
Affiliations

Change in blood-brain barrier permeability during pediatric diabetic ketoacidosis treatment

Monica S Vavilala et al. Pediatr Crit Care Med. 2010 May.

Abstract

Objective: Cerebral edema is a devastating complication of pediatric diabetic ketoacidosis. We aimed to examine blood-brain barrier permeability during treatment of diabetic ketoacidosis in children.

Design: Prospective observational study.

Setting: Seattle Children's Hospital, Seattle, WA.

Patients: Children admitted with diabetic ketoacidosis (pH <7.3, HCO3 <15 mEq/L, glucose >300 mg/dL, and ketosis).

Interventions: None.

Measurements and main results: Subjects underwent two serial paired contrast-enhanced perfusion (gadolinium) and diffusion magnetic resonance imaging scans. Change in whole brain and regional blood-brain barrier permeability (permeability ratio*100 and % permeability ratio change) between illness and recovery were determined. Time 0 reflects start of insulin treatment. Thirteen children (median age 10.0 +/- 1.1 yrs; seven female) with diabetic ketoacidosis were enrolled. Permeability ratio increased from time 1 (first magnetic resonance image after time 0) to time 2 (second magnetic resonance image after time 0) in the frontal cortex (ten of 13 subjects), occipital cortex (ten of 13 subjects), and basal ganglia (nine of 13). Whole brain permeability ratio increased from time 1 to time 2 (160%) and regional increase in permeability ratio was greatest in the frontal cortex (148%) compared with the occipital cortex (128%) and basal ganglia (112%).

Conclusions: Overall, whole brain and regional blood-brain barrier permeability increased in most subjects during diabetic ketoacidosis treatment. The frontal region had more blood-brain barrier permeability than other brain regions examined.

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Conflict of interest statement

The authors have not disclosed any potential conflicts of interest.

Figures

Figure 1
Figure 1
Flowchart for subject screening and enrollment.
Figure 2
Figure 2
Change in whole brain and regional blood– brain barrier permeability in 13 children with diabetic ketoacidosis. Two subjects underwent the first magnetic resonance imaging (MRI) scan outside the a priori specified time periods because of concerns of cerebral edema. The remainder of subjects underwent the first MRI scan 12 to 24 hrs after insulin start and the second MRI scan between 36 and 72 hrs after insulin start. A, Increase in whole brain blood– brain barrier permeability in ten of 3 patients between time 1 (12–35 hrs) and time 2 (40 – 64 hrs) after insulin start. B, Increase in frontal lobe blood– brain barrier permeability in ten of 13 patients between time 1 (12–35 hrs) and time 2 (40 – 64 hrs) after insulin start. C, Increase in occipital lobe blood brain barrier permeability in ten of 13 subjects between time 1 (12–35 hrs) and time 2 (40 – 64 hrs) after insulin start. D, Increase in basal ganglia blood– brain barrier permeability in nine of 13 subjects between time 1 (12–35 hrs after insulin start) and time 2 (40 – 64 hrs after insulin start). please note that the scale on the y-axis ranges from 0 to 0.4.
Figure 3
Figure 3
Increase in blood– brain barrier (BBB) permeability (PS) during diabetic ketoacidosis treatment in two randomly selected subjects. Times for each magnetic resonance imaging scan are given below with the figures.
See this image and copyright information in PMC

Comment in

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