{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T22:19:45Z","timestamp":1774736385917,"version":"3.50.1"},"reference-count":31,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Pediatr Emer Care"],"published-print":{"date-parts":[[2022,2]]},"abstract":"\n Background<\/jats:title>\n Suspected cerebral edema diabetic ketoacidosis (SCEDKA) is more common than perceived with symptoms including altered mentation, headache with vomiting, depressed Glasgow coma scale (GCS), abnormal motor or verbal responses, combativeness, and neurological depression. Suspected cerebral edema diabetic ketoacidosis has been associated with initial diabetic ketoacidosis (DKA) presentation and at start of DKA therapy.<\/jats:p>\n Cerebral oximetry (bihemispheric regional cerebral oxygen saturation [rc<\/jats:sub>SO2<\/jats:sub>] and cerebral blood volume index [CBVI]) can detect increased intracranial pressure (ICP)\u2013induced altered bihemispheric cerebral physiology (rc<\/jats:sub>SO2<\/jats:sub>) (Crit Care Med<\/jats:italic> 2006;34:2217\u20132223, J Pediatr<\/jats:italic> 2013;163: 1111\u20131116, Curr Med Chem<\/jats:italic> 2009;16:94\u2013112, Diabetologia<\/jats:italic> 1985;28:739\u2013742, Pediatr Crit Care Med<\/jats:italic> 2013;14:694\u2013700). In pediatrics, rc<\/jats:sub>SO2<\/jats:sub> of less than 60% or rc<\/jats:sub>SO2<\/jats:sub> of greater than 85% reflects increased ICP and cerebral edema (Crit Care Med<\/jats:italic> 2006;34:2217\u20132223, J Pediatr<\/jats:italic> 2013;163: 1111\u20131116, Curr Med Chem<\/jats:italic> 2009;16:94\u2013112, Diabetologia<\/jats:italic> 1985;28:739\u2013742, Pediatr Crit Care Med<\/jats:italic> 2013;14:694\u2013700). Cerebral oximetry can detect increased ICP\u2013induced altered bihemispheric cerebral physiology (rc<\/jats:sub>SO2<\/jats:sub>, CBVI) and cerebral physiological changes (rc<\/jats:sub>SO2<\/jats:sub>, CBVI changes) during therapeutic mechanical cerebral spinal fluid removal to decrease increased ICP (Crit Care Med<\/jats:italic> 2006;34:2217\u20132223, J Pediatr<\/jats:italic> 2013;163: 1111\u20131116, Curr Med Chem<\/jats:italic> 2009;16:94\u2013112, Diabetologia<\/jats:italic> 1985;28:739\u2013742, Pediatr Crit Care Med<\/jats:italic> 2013;14:694\u2013700).<\/jats:p>\n In the pediatric intensive care units, SCEDKA patients with nonbihemispheric cerebral oximetry showed an initial rc<\/jats:sub>SO2<\/jats:sub> of greater than 90%. Bihemispheric rc<\/jats:sub>SO2<\/jats:sub> with CBVI in SCEDKA patients has the potential to detect the abnormal cerebral physiology and disruptive autoregulation while detecting 3% hypertonic saline solution (HTS) effects on the SCEDKA altered cerebral physiology (rc<\/jats:sub>SO2<\/jats:sub>).<\/jats:p>\n <\/jats:sec>\n \n Purpose<\/jats:title>\n The purposes of this study were to analyze and compare 3% HTS effect on bihemispheric rcSO2 readings, neurological and biochemical parameters in SCEDKA with 3% HTS infusion to non-SCEDKA patients in pediatric emergency department (PED).<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n An observational retrospective comparative analysis study of bihemispheric rcSO2 readings, neurological and biochemical parameters in 2 groups of PED DKA patients were performed: PED DKA patients with SCEDKA +3% HTS infusions versus non-SCEDKA without 3% HTS infusions.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n From 2008 to 2013, of the 1899 PED DKA patients, 60 SCEDKA patients received 3% HTS (5 mL\/kg via peripheral intravenous) infusion (median age of 5 years [range, 3.7\u20137 years]), with 42 new DKA insulin dependent diabetes mellitus onset. Suspected cerebral edema diabetic ketoacidosis patients had GCS of 11 (range, 11\u201312), with consistent SCEDKA signs and symptoms (severe headaches with vomiting, confusion, blurred vision, altered speech, lethargy, and combativeness). Suspected cerebral edema diabetic ketoacidosis patients' initial (0\u20135 minutes) left rc<\/jats:sub>SO2<\/jats:sub> readings were 91.4% (range, 88.4%\u201394.1%) and right was 90.3% (range, 88.6%\u201394.1%) compared with non-SCEDKA patients' left rc<\/jats:sub>SO2<\/jats:sub> readings of 73.2% (range, 69.7%\u201377.8%) and right of 73.2% (range, 67.6%\u201377%) (P<\/jats:italic> < 0.0001). The rc<\/jats:sub>SO2<\/jats:sub> monitoring time before 3% HTS infusion was 54.9 minutes (range, 48.3\u201366.8 minutes) with 3% HTS time effect change: pre\u20133% HTS (54.9 minutes [range, 48.3\u201366.8 minutes]). Before 3% HTS infusion, the left rc<\/jats:sub>SO2<\/jats:sub> readings were 90.0% (range, 89%\u201395%) and right was 91% (range, 86%\u201395%). The 30 to 45 minutes post\u20133% HTS showed that left was 64% (range, 62%\u201369%) and right was 65.4% (range, 63%\u201370%) (P<\/jats:italic> < 0.0001). rc<\/jats:sub>SO2<\/jats:sub> \u0394 change for post\u20133% HTS (0\u201320 minutes) to pre\u20133% HTS was as follows: left, \u221226.58 (\u221229.5 to \u221223.7) (P<\/jats:italic> < 0.0001); right, \u221225.2 (\u221227.7 to \u221222.6) (P<\/jats:italic> < 0.0001). Post\u20133% HTS GCS (14,15) and biochemistry compared with pre\u20133% HTS infusions all improved (P<\/jats:italic> < 0.001).<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n In PED SCEDKA patients, the pre\u20133% HTS bihemispheric rc<\/jats:sub>SO2<\/jats:sub> readings were greater than 90% and had lower GCS than non-SCEDKA patients. The post\u20133% HTS infusion rc<\/jats:sub>SO2<\/jats:sub> readings showed within minutes a substantial reduction compared with non-SCEDKA patients, with no complications. Changes in rc<\/jats:sub>SO2<\/jats:sub> readings after 3% HTS correlated with improved SCEDKA indicators (improved mental status, headache, and GCS) without any complications. We showed that cerebral oximetry in PED SCEDKA patients has shown an initial bihemispheric of greater than 90% readings signifying abnormal bihemispheric cerebral physiology. We also showed the cerebral oximetry's functionality in detecting 3% HTS therapeutic effects on SCEDKA's abnormal cerebral physiology and the beneficial therapeutic effects of 3% HTS infusion in SCEDKA patients. Using cerebral oximetry in pediatric DKA patients' initial cerebral assessment could have a significant impact in detecting SCEDKA patients. Further SCEDKA research using cerebral oximetry should be considered.<\/jats:p>\n <\/jats:sec>","DOI":"10.1097\/pec.0000000000001774","type":"journal-article","created":{"date-parts":[[2019,4,8]],"date-time":"2019-04-08T00:52:07Z","timestamp":1554684727000},"page":"e511-e518","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":3,"title":["Bihemispheric Cerebral Oximetry Monitoring's Functionality in Suspected Cerebral Edema Diabetic Ketoacidosis With Therapeutic 3% Hyperosmolar Therapy in a Pediatric Emergency Department"],"prefix":"10.1097","volume":"38","author":[{"given":"Thomas J.","family":"Abramo","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Szlam","sequence":"additional","affiliation":[{"name":"Pediatric Emergency Medicine Associates, Atlanta, GA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hailey","family":"Hargrave","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zena Leah","family":"Harris","sequence":"additional","affiliation":[{"name":"Lurie Children's Hospital, Northwestern Feinberg School of Medicine, Chicago, IL"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abby","family":"Williams","sequence":"additional","affiliation":[{"name":"Pediatric Emergency Medicine Associates, Atlanta, GA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Meredith","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, College of Medicine, University of Tennessee, Memphis, TN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Madison","family":"Hedrick","sequence":"additional","affiliation":[{"name":"Division of Pediatrics Emergency Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhuopei","family":"Hu","sequence":"additional","affiliation":[{"name":"Division of Biostatistics ACHRI, Department of Pediatrics, Arkansas Children's Hospital Research Institute, College of Medicine, University of Arkansas, Little Rock, AR."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Todd","family":"Nick","sequence":"additional","affiliation":[{"name":"Division of Biostatistics ACHRI, Department of Pediatrics, Arkansas Children's Hospital Research Institute, College of Medicine, University of Arkansas, Little Rock, AR."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cruz Velasco","family":"Gonzalez","sequence":"additional","affiliation":[{"name":"Division of Biostatistics ACHRI, Department of Pediatrics, Arkansas Children's Hospital Research Institute, College of Medicine, University of Arkansas, Little Rock, 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