Acidosis, high blood urea nitrogen tied to cerebral injury in kids before DKA treatment

In children scheduled to receive treatment for diabetic ketoacidosis (DKA), acidosis and high levels of blood urea nitrogen (BUN) appear to increase the risk of cerebral injury, reports a new study.

Researchers conducted a secondary analysis of the prospective study Pediatric Emergency Care Applied Research Network FLUID trial. A total of 106 DKA episodes were included in the present analysis, of which 50 (47.2 percent) had DKA-related cerebral injury. A further seven cases were excluded because injury arose hours after DKA presentation. A parallel group of 1,227 children with uncomplicated DKA was also included as a comparison.

Children with cerebral injury at presentation showed lower pH and bicarbonate levels, as well as elevations in glucose, glucose-corrected sodium, BUN, and creatinine concentrations. Headaches, meanwhile, developed at comparable frequencies between groups.

Multivariable analyses showed that pH was a significant correlate of cerebral injury at presentation, with lower pH (more acidic) increasing the likelihood of such an outcome by nearly 80 percent (odds ratio [OR], 0.21, 95 percent confidence interval [CI], 0.15–0.29; p<0.001). BUN was also significantly and positively associated with cerebral injury (OR, 1.09, 95 percent CI, 1.06–1.12; p<0.001).

Excluding children with altered mental status at presentation did not meaningfully affect the primary outcomes.

“These findings are consistent with the hypothesis that factors intrinsic to the DKA episode are likely responsible for causing DKA-related cerebral injury rather than treatment-related factors,” the researchers said.