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Hyperemia and impaired cerebral autoregulation in a surgical patient with diabetic ketoacidosis

[L’hyperémie et l’autorégulation cérébrale altérée chez un patient de chirurgie atteint d’acidocétose diabétique]

Monica S. Vavilala, MD^*, Michael J. Souter, MB CHB FRCA and Arthur M. Lam, MD FRCPC

^* From the Departments of Anesthesiology,
Pediatrics, and
Neurological Surgery, University of Washington, Seattle, Washington, USA.

Address correspondence to: Dr. Monica S. Vavilala, Department of Anesthesiology, Harborview Medical Center, 325 Ninth Avenue, Box 359724, Seattle, Washington 98104, USA. Phone: 206-731-3059; Fax: 206-731-8009; E-mail: vavilala{at}u.washington.edu

Purpose: We describe cerebral hyperemia and impaired cerebral autoregulation documented with transcranial Doppler (TCD) ultrasonography in an adult patient with diabetic ketoacidosis (DKA) and sepsis presenting for surgery.

Clinical features: Middle cerebral artery flow velocity was increased relative to PaCO₂ (Vmca 52 cm·sec^–1; PaCO₂ 22 mmHg) and the autoregulatory index (ARI) was 0 prior to surgery. Twenty hours after admission and treatment, cerebral hyperemia resolved (Vmca 52 cm·sec^–1 ; PaCO₂ 35 mmHg) and cerebral autoregulation returned to normal (ARI 0.91).

Conclusion: To our knowledge, this is the first description of impaired cerebral autoregulation in adult DKA. Our observations suggest a relationship between cerebral hyperemia and impaired cerebral autoregulation in DKA.