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Cerebral Blood Flow and Cerebral Edema in Rats with Diabetic Ketoacidosis

¹Department of Physiology and Membrane Biology and
²Department of Pediatrics, University of California, One Shields Avenue, Davis, CA 95616

OBJECTIVE: Cerebral edema (CE) is a potentially life-threatening complication of DKA in children. Osmotic fluctuations during DKA treatment have been considered responsible, but recent data instead suggest that cerebral hypoperfusion may be involved, and that activation of cerebral ion transporters may occur. Diminished cerebral blood flow (CBF) during DKA, however, has not been previously demonstrated. We investigated CBF and edema formation in a rat model of DKA and determined the effects of bumetanide, an inhibitor of Na-K-Cl cotransport.

RESEARCH DESIGN AND METHODS: Juvenile rats with streptozotocin-induced DKA were treated with intravenous saline and insulin, similar to human treatment protocols. CBF was determined by magnetic resonance (MR) perfusion weighted imaging before and during treatment and CE was assessed by determining apparent diffusion coefficients (ADC) using MR diffusion weighted imaging.

RESULTS: CBF was significantly reduced in DKA and was responsive to alterations in pCO₂. ADC values were reduced, consistent with cell swelling. The reduction in ADC correlated with dehydration, as reflected in blood urea nitrogen concentrations. Bumetanide caused a rapid rise in ADC of DKA rats without significantly changing CBF, while saline/insulin caused a rapid rise in CBF and a gradual rise in ADC. DKA rats treated with bumetanide plus saline/insulin showed a trend toward more rapid rise in cortical ADC and a larger rise in striatal CBF than those observed with saline/insulin alone.

CONCLUSIONS: These data demonstrate that CE in DKA is accompanied by cerebral hypoperfusion before treatment and suggest that blocking Na-K-Cl cotransport may reduce cerebral cell swelling.

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