Bedside sonographic measurements of optic nerve sheath diameter in children with diabetic ketoacidosis

Abstract

Background: Bedside sonographic assessment of the optic nerve sheath has gained popularity for evaluating intracranial pressure in recent years.Objective: To investigate the bedside sonographic measurements of optic nerve sheath diameter (ONSD) and ONSD/eyeball diameter ratios, which are related with cerebral edema (CE), in children with diabetic ketoacidosis (DKA) before and after treatment.Methods: Children aged 12 months to 18 years, who were diagnosed with DKA were included. The ONSD was measured at 3 mm posterior to the globe in the anterior axial transbulbar view. The eyeball transverse diameter (ETD) and eyeball vertical diameter (EVD) were measured and ratios of ONSD/ETD and ONSD/EVD were calculated. Bedside ultrasound (US) examinations were performed at the beginning and at the end of fluid therapy.Results: About 43 patients were enrolled. About 12 (27.9%) patients had mild, 14 (32.6%) moderate, and 17 (39.5%) severe DKA. At baseline, the ONSD measurements and ratios were significantly higher in severe DKA group than in those with mild or moderate DKA group. All ONSD measurements, ONSD/ETD, and ONSD/ EVD ratios at the end of therapy were significantly lower compared with baseline measurements. At the end of therapy, ONSD measurements and ratios were similar among DKA severity groups. Conclusion:The ONSD measurements and ratios decreased from the beginning of DKA treatment, which could be considered as an indicator of an increase in intracranial pressure at the time of admission. Ocular US may serve as a promising tool to perform further risk stratification of children with DKA and to identify DKArelated CE.

Bedside ocular ultrasonography for diagnosing increased intracranial pressure in patients with leptomeningeal metastases from non‐small‐cell lung cancer

“…There have been some studies on ultrasonic measurement of ONSD for the diagnosis of high ICP, 20 , 21 while there are relatively few studies on the measurement of ODH for the diagnosis of high ICP. Rajajee V et al compared the accuracy of optic nerve ultrasound in assessing intracranial pressure with sharp fluctuations and stability.…”

“…Our study suggested that these variables may be utilized as a possible alternative, which is consistent with other studies. 16 , 21 , 24 However, we still need more investigations before using the ONSD/ETD ratio and other variables for clinical decision‐making. Our study has several strengths.…”

The Evaluation and Management of Pediatric Diabetic Ketoacidosis: A Comprehensive Review

“…Bedside sonographic measurement of the optic nerve sheath diameter as a surrogate marker for increased intracranial pressure has been shown to directly correlate with the severity of DKA. 70…”

“…Yet it is important to emphasize that the diagnosis of CE is clinical, and if signs are present, immediate therapeutic intervention takes precedence over imaging. Bedside sonographic measurement of the optic nerve sheath diameter as a surrogate marker for increased intracranial pressure has been shown to directly correlate with the severity of DKA 70.…”

Optic nerve sheath diameter in patients with hepatic encephalopathy

“…It has been shown that there is a positive correlation between ONSD and an increase in ICP, however, most of these studies have examined structural etiologies of increased ICP such as intracranial edema, intracranial hemorrhage, and ischemic cerebrovascular accident [2][3][4][5]. On the other hand, an increase in ICP is also seen in a metabolic coma, such as hypertensive encephalopathy, diabetic ketoacidosis, and HE [6][7][8][9][10]. One study has also reported that increased ONSD is correlated with the degree of HE in acute liver failure in children in a study, but this association has not yet been demonstrated in adults [11].…”