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PT  - JOURNAL ARTICLE
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
TI  - Detection of Cerebral β-Hydroxy Butyrate, Acetoacetate, and Lactate on Proton MR Spectroscopy in Children with Diabetic Ketoacidosis
DP  - 2005 May 01
TA  - American Journal of Neuroradiology
PG  - 1286--1291
VI  - 26
IP  - 5
4099  - http://www.ajnr.org/content/26/5/1286.short
4100  - http://www.ajnr.org/content/26/5/1286.full
SO  - Am. J. Neuroradiol.2005 May 01; 26
AB  - 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 β-hydroxy butyrate (βOHB) 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 βOHB (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: βOHB 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 &amp;gt;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, βOHB 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 βOHB peaks to lactate.