{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T11:43:09Z","timestamp":1778154189930,"version":"3.51.4"},"reference-count":46,"publisher":"Wiley","license":[{"start":{"date-parts":[[2023,2,28]],"date-time":"2023-02-28T00:00:00Z","timestamp":1677542400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["5T32DK007699-40"],"award-info":[{"award-number":["5T32DK007699-40"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatric Diabetes"],"published-print":{"date-parts":[[2023,2,28]]},"abstract":"<jats:p>The incidence of pediatric diabetic ketoacidosis (DKA) increased during the peak of the COVID-19 pandemic. The objective of this study was to investigate whether rates of hyperosmolar therapy administration for suspected clinically apparent brain injury (CABI) complicating DKA also increased during this period as compared to the three years immediately preceding the pandemic and to compare the characteristics of patients with suspected CABI before the pandemic, patients with suspected CABI during the peak of the pandemic, and those with DKA but without suspected CABI during the pandemic. Patients aged \u226418\u2009years presenting with DKA before (March 11, 2017\u2013March 10, 2020) and during the peak of the pandemic (March 11, 2020\u2013March 10, 2021) were identified through a rigorous search of two databases. Predefined criteria were used to diagnose suspected CABI. Biochemical, clinical, and sociodemographic data were collected from a comprehensive review of the electronic medical record. The proportion of patients with DKA who received hyperosmolar therapy was significantly higher (<jats:inline-formula>\n                     <a:math xmlns:a=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M1\">\n                        <a:mi>P<\/a:mi>\n                     <\/a:math>\n                  <\/jats:inline-formula>\u2009=\u20090.014) during the pandemic compared to the prepandemic period; however, this was only significant among patients with newly diagnosed diabetes. Both groups with suspected CABI had more severe acidosis, lower Glasgow Coma Scale scores, and longer hospital admissions (<jats:inline-formula>\n                     <c:math xmlns:c=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M2\">\n                        <c:mi>P<\/c:mi>\n                     <\/c:math>\n                  <\/jats:inline-formula>\u2009&lt;\u20090.001 for all) than cases without suspected CABI. During the pandemic, the blood urea nitrogen concentration was significantly higher in patients with suspected CABI than those without suspected CABI, suggesting they were more severely dehydrated. The clinical, biochemical, and sociodemographic characteristics of patients with suspected CABI were indistinguishable before and during the pandemic. In conclusion, administration of hyperosmolar therapy for suspected CABI was more common during the peak of the COVID-19 pandemic, possibly a result of delayed presentation, highlighting the need for increased awareness and early recognition of the signs and symptoms of diabetes and DKA, especially during future surges of highly transmissible infections.<\/jats:p>","DOI":"10.1155\/2023\/5123197","type":"journal-article","created":{"date-parts":[[2023,3,1]],"date-time":"2023-03-01T00:20:09Z","timestamp":1677630009000},"page":"1-10","source":"Crossref","is-referenced-by-count":2,"title":["Increased Use of Hyperosmolar Therapy for Suspected Clinically Apparent Brain Injury in Pediatric Patients with Diabetic Ketoacidosis during the Peak of the COVID-19 Pandemic"],"prefix":"10.1155","volume":"2023","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3685-1387","authenticated-orcid":true,"given":"Svetlana","family":"Azova","sequence":"first","affiliation":[{"name":"Division of Endocrinology, Boston Children\u2019s Hospital, Boston, Massachusetts 02115, USA"},{"name":"Department of Pediatrics, Harvard Medical School, Boston, Massachusetts 02115, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5732-3359","authenticated-orcid":true,"given":"Enju","family":"Liu","sequence":"additional","affiliation":[{"name":"Institutional Centers for Clinical and Translational Research, Boston Children\u2019s Hospital, Boston, Massachusetts 02115, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6220-6758","authenticated-orcid":true,"given":"Joseph","family":"Wolfsdorf","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Boston Children\u2019s Hospital, Boston, Massachusetts 02115, USA"},{"name":"Department of Pediatrics, Harvard Medical School, Boston, Massachusetts 02115, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","reference":[{"key":"1","doi-asserted-by":"publisher","DOI":"10.5114\/pedm.2020.101003"},{"key":"2","doi-asserted-by":"publisher","DOI":"10.1016\/s2213-8587(21)00208-4"},{"key":"3","doi-asserted-by":"publisher","DOI":"10.1111\/pedi.13205"},{"key":"4","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.13445"},{"key":"5","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2021-050856"},{"key":"6","doi-asserted-by":"publisher","DOI":"10.1089\/dia.2021.0110"},{"key":"7","doi-asserted-by":"publisher","DOI":"10.2147\/dmso.s294458"},{"key":"8","doi-asserted-by":"publisher","DOI":"10.1111\/dme.14640"},{"key":"9","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(22)00246-7"},{"key":"10","doi-asserted-by":"publisher","DOI":"10.1111\/pedi.12701"},{"key":"11","doi-asserted-by":"publisher","DOI":"10.1056\/nejm200101253440404"},{"key":"12","doi-asserted-by":"publisher","DOI":"10.1370\/afm.405"},{"key":"13","volume-title":"International Standard Classification of Occupations (ISCO-08): Structure, Group Definitions and Correspondence Tables","author":"International Labour Organization","year":"2012"},{"key":"14","article-title":"COVID Data Tracker","author":"Centers for Disease Control and Prevention","year":"2022"},{"key":"15","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-006-0363-8"},{"key":"16","doi-asserted-by":"publisher","DOI":"10.1016\/s0887-8994(99)00079-x"},{"key":"17","doi-asserted-by":"publisher","DOI":"10.2337\/dc10-0102"},{"key":"18","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2004.12.041"},{"key":"19","doi-asserted-by":"publisher","DOI":"10.1097\/pcc.0b013e3182196c6d"},{"key":"20","doi-asserted-by":"publisher","DOI":"10.1080\/13102818.2016.1221740"},{"key":"21","doi-asserted-by":"publisher","DOI":"10.1542\/peds.113.2.e133"},{"key":"22","doi-asserted-by":"publisher","DOI":"10.1177\/0009922815617975"},{"key":"23","doi-asserted-by":"publisher","DOI":"10.1067\/mpd.2002.128888"},{"key":"24","doi-asserted-by":"publisher","DOI":"10.1097\/01.pcc.0000164343.20418.37"},{"key":"25","doi-asserted-by":"publisher","DOI":"10.1097\/01.pcc.0000164636.58381.8f"},{"key":"26","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.13.1.22"},{"key":"27","doi-asserted-by":"publisher","DOI":"10.1016\/0140-6736(90)91587-z"},{"key":"28","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-543x.2006.00156.x"},{"issue":"5","key":"29","first-page":"895","article-title":"Cerebral proton magnetic resonance spectroscopy in children with diabetic ketoacidosis","volume":"28","author":"S. 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