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Author Notes:

Address correspondence to: Nicole Glaser, MD, Department of Pediatrics, University of California, Davis, School of Medicine, 2516 Stockton Blvd., Sacramento, California, 95817, nsglaser@ucdavis.edu, Phone: (916) 734-8223, Fax: (916) 734-7070

We thank Michael Buonocore, MD, for his implementation of MRI programs for noninvasive measurement of physiological processes, including development of the protocol for measurement of brain water content that was used in this study.

The authors declare no conflicts of interest.


Research Funding:

Funded by American Diabetes Association (7-01-CR-14 [to N.G]) and by National Institute of Neurological Disorders and Stroke (R01 NS048610 [to NG)].


  • Science & Technology
  • Life Sciences & Biomedicine
  • Pediatrics

Regional Brain Water Content and Distribution During Diabetic Ketoacidosis


Journal Title:

Journal of Pediatrics


Volume 180


, Pages 170-176

Type of Work:

Article | Post-print: After Peer Review


Objective To characterize regional differences in brain water distribution and content during diabetic ketoacidosis (DKA) in children and determine whether these differences correlate with regional vascular supply. Study design We compared changes in brain water distribution and water content in different brain regions during DKA by analyzing magnetic resonance diffusion weighted imaging data collected during DKA and after recovery in 45 children ( < 18 years of age). We measured the apparent diffusion coefficient (ADC) of water in the frontal and occipital cortex, basal ganglia, thalamus, hippocampus, and medulla. Brain water content was also measured in a subset of patients. Results ADC values were elevated (suggesting vasogenic cerebral edema) in the frontal cortex, basal ganglia, thalamus, and hippocampus during DKA. In contrast, ADC values in the medulla and the occipital cortex were not increased during DKA, and ADC changes in the medulla tended to be negatively correlated with other regions. Regions supplied by the anterior/middle cerebral artery circulation had greater elevations in both ADC and brain water content during DKA compared with regions supplied by the posterior cerebral artery circulation. Conclusions ADC changes during DKA in the brainstem contrast with those of other brain regions, and changes in both ADC and brain water content during DKA vary according to regional vascular supply. These data suggest that brainstem blood flow might possibly be reduced during DKA concurrent with hyperemia in other brain regions.

Copyright information:

© 2016 Elsevier Inc.

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