Optic Nerve and Cerebral Edema in the Course of Diabetic Ketoacidosis

Abstract

In the recent years we have been observing an increased incidence of type 1 diabetes in children and adolescents. This leads to a more frequent acute complication of type 1 diabetes among children with hyperglycemia. The most common of these is diabetic ketoacidosis (DKA), while cerebral edema is the most dangerous. In children with DKA, cerebral edema most often presents with clinical symptoms but may also appear in the so-called “subclinical” form. That is why the search continues for new methods of assessing and monitoring cerebral edema in the course of DKA treatment. Ultrasonographic optic nerve sheath diameter (US ONSD) assessment is performed in various clinical scenarios when cerebral edema is suspected. It is most often performed in adult patients but increasingly often in children. US ONSD assessment is useful in the treatment of DKA in children with type 1 diabetes. This manuscript provides an overview of research results available in PubMed and other available databases on the course of treatment of DKA in children with type 1 diabetes.

Measurement of corneal thickness, optic nerve sheath diameter and retinal nerve fiber layer as potential new non-invasive methods in assessing a risk of cerebral edema in type 1 diabetes in children

“…Hansen et al observed a tendency to decrease the dimensions of ONSD after compensation of metabolic disorders, but the study was carried out on a low number of patients [ 11 ]. Szmygel et al noticed a significant reduction in the ONSD dimension in non-DKA patients and a tendency in the DKA group of patients with T1D [ 10 ].…”

“…These methods should be, however, widely available and performable before the treatment is started and the classical methods of neuroimaging are applied. Some recent studies on the potential use of transorbital ultrasonography (USG) to evaluate the risk of CE in the small groups of pediatric patients with DKA revealed encouraging results [ 10 – 12 ]. Other promising methods allowing an assessment of retinal nervous layer seem to be the optical coherent tomography (OCT) study [ 13 ] and a pachymetry evaluating corneal thickness [ 14 , 15 ].…”

The Role of Transocular Ultrasound in the Assessment of Neurotoxicity-Related Encephalopathy in Mushroom Poisoning

“…To evaluate cerebral oedema due to diabetic ketoacidosis, ultrasonographic evaluation may be used instead of examination for papilloedema because it appears earlier. However, it is suggested to be more effective to detect patients under risk for cerebral oedema development rather than for monitorisation (23). Studies have been performed that used ONSD for diagnosis and follow-up of altitude sickness.…”

EDITORIAL (Thematic Issue: Retinal Neurodegeneration in the Course of Diabetes: Neuroprotection as a Potential Treatment Target)

“…Ł. et al . to present their conception of studies of the optic nerve assessment in diabetic ketoacidosis (DKA) in children with type 1 diabetes mellitus (T1DM) [ 7 ]. In the article “ Optic nerve and cerebral edema in the course of diabetic ketoacidosis ” the authors present comprehensive evidence supporting the need for ultrasound examination of the optic nerve sheath diameter as an additional tool to estimate the risk of brain edema in T1DM children in the course of DKA treatment.…”

“…This novel technique seems to be a promising, non-invasive bedside tool. Currently the use of ultrasound is gaining popularity, particularly in the Emergency Room and Critical Care settings [ 7 ]. What Furthermore, long-term consequences of brain edema can be seen in the group of patients previously treated for diabetic ketoacidosis?…”