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Detection of cerebral {beta}-hydroxy butyrate, acetoacetate, and lactate on proton MR spectroscopy in children with diabetic ketoacidosis.
AJNR Am J Neuroradiol 2005; 26(5):1286-91AA

Abstract

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 beta-hydroxy butyrate (betaOHB) 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 > or =72 hours after the start of treatment. MRS was evaluated for peaks corresponding to betaOHB (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

betaOHB 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, betaOHB 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 betaOHB peaks to lactate.

Authors+Show Affiliations

Department Radiology, University of California, Davis School of Medicine, Sacramento, CA 95817, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15891198

Citation

Wootton-Gorges, Sandra L., et al. "Detection of Cerebral {beta}-hydroxy Butyrate, Acetoacetate, and Lactate On Proton MR Spectroscopy in Children With Diabetic Ketoacidosis." AJNR. American Journal of Neuroradiology, vol. 26, no. 5, 2005, pp. 1286-91.
Wootton-Gorges SL, Buonocore MH, Kuppermann N, et al. Detection of cerebral {beta}-hydroxy butyrate, acetoacetate, and lactate on proton MR spectroscopy in children with diabetic ketoacidosis. AJNR Am J Neuroradiol. 2005;26(5):1286-91.
Wootton-Gorges, S. L., Buonocore, M. H., Kuppermann, N., Marcin, J., Dicarlo, J., Neely, E. K., ... Glaser, N. (2005). Detection of cerebral {beta}-hydroxy butyrate, acetoacetate, and lactate on proton MR spectroscopy in children with diabetic ketoacidosis. AJNR. American Journal of Neuroradiology, 26(5), pp. 1286-91.
Wootton-Gorges SL, et al. Detection of Cerebral {beta}-hydroxy Butyrate, Acetoacetate, and Lactate On Proton MR Spectroscopy in Children With Diabetic Ketoacidosis. AJNR Am J Neuroradiol. 2005;26(5):1286-91. PubMed PMID: 15891198.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Detection of cerebral {beta}-hydroxy butyrate, acetoacetate, and lactate on proton MR spectroscopy in children with diabetic ketoacidosis. AU - Wootton-Gorges,Sandra L, AU - Buonocore,Michael H, AU - Kuppermann,Nathan, AU - Marcin,James, AU - Dicarlo,Joseph, AU - Neely,E Kirk, AU - Barnes,Patrick D, AU - Glaser,Nicole, PY - 2005/5/14/pubmed PY - 2006/1/28/medline PY - 2005/5/14/entrez SP - 1286 EP - 91 JF - AJNR. American journal of neuroradiology JO - AJNR Am J Neuroradiol VL - 26 IS - 5 N2 - 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 beta-hydroxy butyrate (betaOHB) 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 > or =72 hours after the start of treatment. MRS was evaluated for peaks corresponding to betaOHB (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: betaOHB 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, betaOHB 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 betaOHB peaks to lactate. SN - 0195-6108 UR - https://www.unboundmedicine.com/medline/citation/15891198/Detection_of_cerebral_{beta}_hydroxy_butyrate_acetoacetate_and_lactate_on_proton_MR_spectroscopy_in_children_with_diabetic_ketoacidosis_ L2 - http://www.ajnr.org/cgi/pmidlookup?view=long&pmid=15891198 DB - PRIME DP - Unbound Medicine ER -