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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 26:1286-1291, May 2005
© 2005 American Society of Neuroradiology

PEDIATRICS

Detection of Cerebral ß-Hydroxy Butyrate, Acetoacetate, and Lactate on Proton MR Spectroscopy in Children with Diabetic Ketoacidosis

Sandra L. Wootton-Gorges^a, Michael H. Buonocore^a, Nathan Kuppermann^b,c, James Marcin^b, Joseph DiCarlo^d, E. Kirk Neely^d, Patrick D. Barnes^e and Nicole Glaser^b

^a Department Radiology, University of California, Davis School of Medicine
^b Department Pediatrics, University of California, Davis School of Medicine
^c Department Internal Medicine, Division of Emergency Medicine, University of California, Davis School of Medicine
^d Department of Pediatrics, Stanford University School of Medicine
^e Radiology, Stanford University School of Medicine

Address reprint requests to Sandra L. Wootton-Gorges, MD, Department of Radiology, UCDMC, 4860 Y Street, Suite 3100, Sacramento, CA 95817

BACKGROUND AND PURPOSE: Ketone bodies provide important alternate fuel for brain metabolism, and their transport into the brain increases with prolonged fasting. During diabetic ketoacidosis (DKA), serum ketone concentrations markedly increase; however, little is known about whether ketone bodies accumulate in cerebral tissues during DKA. We used proton MR spectroscopy (MRS) to detect cerebral ß-hydroxy butyrate (ßOHB) and acetone/acetocaetate (AcAc) in children with DKA.

METHODS: Twenty-five children underwent brain MRS: nine within 4 hours of the start of treatment for DKA; 11, at 4–8 hours; and five, at 8–12 hours. MRS was repeated after their recovery from the DKA episode at 72 hours after the start of treatment. MRS was evaluated for peaks corresponding to ßOHB (doublet centered on 1.20 ppm) and lactate (doublet centered on 1.33 ppm). Difference spectroscopy was used to identify the AcAc peak at 2.22–2.26 ppm.

RESULTS: ßOHB was detected in 13 children (52%), more frequently within 4 hours (eight children, 89%) than after 4 hours (five children, 31%). AcAc was detected in 15 children (60%), more frequently at >4 hours after the start of treatment (12 patients, 75%) than in the first 4 hours (three patients, 33%). Lactate was detected in five children (18%), all within the first 8 hours of treatment.

CONCLUSION: In children, ßOHB and AcAc accumulate in the brain during DKA, and they can be detected on MRS. Care should be taken in interpreting MRS results in patients with DKA to avoid erroneously attributing ßOHB peaks to lactate.

This article has been cited by other articles:

				F. H. Mahmud, D. A. Ramsay, S. D. Levin, R. N. Singh, T. Kotylak, and D. D. Fraser Coma With Diffuse White Matter Hemorrhages in Juvenile Diabetic Ketoacidosis Pediatrics, December 1, 2007; 120(6): e1540 - e1546. [Abstract] [Full Text] [PDF]

				S.L. Wootton-Gorges, M.H. Buonocore, N. Kuppermann, J.P. Marcin, P.D. Barnes, E.K. Neely, J. DiCarlo, T. McCarthy, and N.S. Glaser Cerebral Proton Magnetic Resonance Spectroscopy in Children with Diabetic Ketoacidosis AJNR Am. J. Neuroradiol., May 1, 2007; 28(5): 895 - 899. [Abstract] [Full Text] [PDF]