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Transcranial doppler ultrasound assessment of intracranial hemodynamics in children with diabetic ketoacidosis
Author(s) -
Hoffman William H.,
Pluta Ryszard M.,
Fisher Asma Q.,
Wagner Michele B.,
Yanovski Jack A.
Publication year - 1995
Publication title -
journal of clinical ultrasound
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.272
H-Index - 61
eISSN - 1097-0096
pISSN - 0091-2751
DOI - 10.1002/jcu.1870230903
Subject(s) - medicine , transcranial doppler , hematocrit , diabetic ketoacidosis , cerebral blood flow , hemodynamics , intracranial pressure , anesthesia , pathophysiology , blood flow , cardiology , insulin
Abstract The pathophysiology of acute neurological complications of diabetic ketoacidosis (DKA) in children and adolescents is not completely understood. We sought to establish whether transcranial Doppler (TCD) was able to monitor the changes of cerebral blood flow regulatory mechanisms, as measured by cerebral blood velocities (CBF‐V), Gosling's pulsatility index (PI), and cerebral vascular reactivity (VR), prior to and during treatment of DKA. The increased values of PI suggested an increase of intracranial pressure (ICP) due to the existence of cerebral vasoparalysis, based on the low values of VR prior to treatment and 6 hours after initiation of treatment. At 24 hours, the correction of hematocrit and pH was associated with a significant decrease of PI, suggesting a decrease of ICP, likely due to a return of vascular tone in response to the low PaCO 2 . This was further supported by an increase of VR in all patients. At 48 hours, when PaCO 2 returned to normal, the PI remained low and the VR increased further, suggesting a complete reversal of vasoparalysis and a return of cerebral blood flow regulatory mechanisms. © 1995 John Wiley & Sons, Inc.