Determination of cerebral edema with serial measurement of optic nerve sheath diameter during treatment in children with diabetic ketoacidosis: a longitudinal study

Kendir, Özlem Tolu; Yılmaz, Hayri Levent; Özkaya, Ahmet Kağan; Turan, İhsan; Gökay, Sinem Sarı; Bilen, Sevcan; Yildizdaş, Riza; Yüksel, Bilgin

doi:10.1515/jpem-2019-0016

Cited by 13 publications

(5 citation statements)

References 30 publications

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“…We found a few studies performed on small number of patients. Kendir et al observed changes in ONSD measurements during DKA treatment, reaching the highest values at 12th to 16th hour of therapy 25 . Hansen et al reported a tendency to decrease in ONSD measurements after resolution of acidosis, in consistent with our findings but the study was carried out on a very low number of patients 26 .…”

Section: Discussionsupporting

confidence: 91%

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

et al. 2021

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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.

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Section: Discussionsupporting

confidence: 91%

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

et al. 2021

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“…Kendir et al showed that an increase in ONSD in 31 children with diabetic ketoacidosis, in moderate-severe diabetic ketoacidosis, reached the highest diameter, and ONSD decreased after treatment. It has been reported that brain edema can be monitored by measuring ONSD during the treatment of these patients, and it can contribute to clinical treatments such as fluid therapy [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…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].…”

Section: Introductionmentioning

confidence: 99%

Optic nerve sheath diameter in patients with hepatic encephalopathy

Colak

Basakci²,

Bayram³

et al. 2022

PLoS ONE

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Background This study aims to reveal whether the optic nerve sheath diameter (ONSD) increases in hepatic encephalopathy (HE) patients, and to determine ONSD is associated with the poor prognosis of patients with HE. Methods and material In this retrospective case-control study, HE patients who underwent cranial computerized tomography (CT) were included in the case group; and the patients who underwent CT for other reasons for the same age and gender and were normally interpreted were included in the control group. ONSD measurements in the case and control groups and clinical grades of HE with in-hospital mortality and ONSD measurements were compared in the case group. Results This study was done with 74 acute HE patients and 74 control patients. The mean age was 62.9 ± 11.0 years and 67.6% of patients were male in both groups. The ONSD in the case group was higher than the control group (5.27-mm ± 0.82 vs 4.73 mm ± 0.57, p <0.001). In the case group, the ONSD was 5.30 mm ± 0.87 in survivors, and 5.21 ± 0.65 in non-survivors (P = 0.670). There was no significant difference between the West Haven HE grade (P = 0.348) and Child-Pugh Score (P = 0.505) with ONSD measurements. Conclusion We have shown that ONSD increases in HE patients compared to the control group. ONSD was not related to the Child-Pugh Score, HE grade, and in-hospital mortality.

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“…Overt raised intracranial pressure (ICP) is rare. However, neuroimaging and optic nerve sheath diameter changes in children with severe DKA has shown that subtle cerebral edema can be missed clinically and can lead to neurological deficits (23,24).…”

Section: Challengesmentioning

confidence: 99%

Application of bench studies at the bedside to improve outcomes in the management of severe diabetic ketoacidosis in children—a narrative review

Ravikumar¹,

Bansal²

2021

Transl Pediatr

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In this review, we address a few key issues and the challenges faced in the management of severe diabetic ketoacidosis (DKA) in children, highlighting the existing standard of care, supported by evidence and bench studies. Background:The classic triad of DKA namely hyperglycemia, metabolic acidosis and ketonemia warrants immediate attention with fluids and insulin. Correction of dehydration in DKA is of utmost priority and the calculation of fluid volume and choice of fluid have remained a matter of debate. Insulin therapy, to halt the ketone production, in DKA has undergone wide variations in dose and preparation since its discovery.Although the mortality due to severe DKA has remarkably decreased, complications like cerebral edema and acute kidney injury (AKI) continue to haunt the intensivists and endocrinologists on a few occasions.Methods: We have selected a few important questions in the management of severe DKA in children, addressing the challenges, reviewing the studies, guidelines and bedside practices with evidence in this narrative review. Conclusions:The focus of management should be to understand and normalise the deranged physiology rather than trying to get normal laboratory reports. This needs careful understanding of the pathogenesis and deriving conclusion from bench studies. With newer studies and evidence, guidelines are revised every few years. There is a trend towards more conservative therapy, with continuous and advanced monitoring.Switching to subcutaneous insulin and oral hydration is done as early as possible with clinical monitoring and resolution of DKA. Management of severe DKA in children can vary from simple fluid titration and insulin infusion in mild cases to a scenario with multiorgan dysfunction requiring intensive monitoring and advanced organ support. Individualisation of therapy to suit the needs with the available evidence and expertise is extremely essential.

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Determination of cerebral edema with serial measurement of optic nerve sheath diameter during treatment in children with diabetic ketoacidosis: a longitudinal study

Cited by 13 publications

References 30 publications

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

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

Optic nerve sheath diameter in patients with hepatic encephalopathy

Application of bench studies at the bedside to improve outcomes in the management of severe diabetic ketoacidosis in children—a narrative review

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