الفهرس 
Pediatric Diabetic KetoacidosisOnly 14 pages are availabe for public view
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Abstract
Background: Children with type 1 diabetes mellitus (T1DM) presenting with diabetic ketoacidosis (DKA) are at risk of cerebrovascular complications due to several factors associated with procoagulant state. Cerebrovascular insult (CVI) is a known and significant morbidity of DKA; yet, its prevalence is underestimated. Untreated cerebral hypoperfusion in DKA may lead to cerebral injury, arterial ischemic stroke, cerebral venous thrombosis, and hemorrhagic stroke. Aim: This study assessed the cerebral perfusion status among children and adolescents with DKA during and after the resolution of DKA. Methods: Forty children and adolescents with T1DM presenting with DKA were assessed for severity of DKA, diabetes-duration, insulin therapy, Rappaport coma/ Near coma scale, Rancho los amigos levels of cognitive functioning scale, glycated-hemoglobin (HbA1c), D-dimer, international normalized ratio (INR) and brain magnetic resonance imaging (MRI) during and 2 weeks after the resolution of the DKA. Results: The mean age of the children and adolescents with T1DM presenting with DKA was 11.40 ± 2.82 years; their median diabetes-duration was 3 years; their mean HbA1c was 13.54 ± 2%. There was significant increase in platelet (P=0.005), D-dimer (P<0.001), serum creatinine (P<0.001) and pulse wave velocity (PWV) (P=0.004) during attack of DKA while there was significance decrease in apparent diffusion coefficient (ADC) (P<0.001). There were 30% of children and adolescents with T1DM had ischemic MRI changes during DKA. In children and adolescents with ischemic MRI changes during DKA, there was significant increase in severity of DKA (P=0.003), HbA1c (P=0.016), INR (P=0.002), D-dimer (P<0.001), serum creatinine (P=0.003). HbA1c was negatively correlated to ADC while positively correlated to PWV. Conclusion: A significant cerebral hypoperfusion occurs during the DKA which is correlated with the DKA severity and D-dimer levels.