Recent data suggest that DKA may contribute to cognitive impairment in children with type 1 DM. We measured the NAA/Cr ratio in a teenager during and following 2 separate episodes of DKA without clinically apparent cerebral edema. The NAA/Cr ratio decreased during DKA and improved following recovery. However, the NAA/Cr value was lower after the second episode of DKA (1.76) than after the first (1.97). These findings provide support for the hypothesis that neuronal injury may result from DKA.
Wootton-Gorges, S. L., Buonocore, M. H., Caltagirone, R. A., Kuppermann, N., & Glaser, N. S. (2010). Progressive decrease in N-acetylaspartate/creatine ratio in a teenager with type 1 diabetes and repeated episodes of ketoacidosis without clinically apparent cerebral edema: Evidence for permanent brain injury. American Journal of Neuroradiology, 31(4), 780–781. https://doi.org/10.3174/ajnr.A1829