Continuous non-invasive end-tidal CO2 monitoring in pediatric inpatients with diabetic ketoacidosis

Agus, Michael S. D.; Alexander, Jamin L.; Mantell, Patricia

doi:10.1111/j.1399-5448.2006.00186.x

Cited by 35 publications

(21 citation statements)

References 14 publications

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“…12 At least 3 groups have suggested end-tidal CO 2 as a simpler and less invasive diagnostic or monitoring tool for DKA. [13][14][15] Although end-tidal CO 2 had a strong linear correlation with vpH and HCO3 concentration, the agreement was not narrow enough to confirm DKA, especially in cases of mild acidosis, 14,15 and its measurement has not been widely adopted. Another attempt to simplify the initial evaluation of patients with DKA has been with the measurement of electrolytes by using a VBG analyzer.…”

Section: Discussionmentioning

confidence: 99%

Use of Serum Bicarbonate to Substitute for Venous pH in New-Onset Diabetes

Oettingen¹,

Wolfsdorf

Feldman

et al. 2015

Pediatrics

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OBJECTIVE: To investigate whether serum bicarbonate (HCO3) levels can be used to accurately diagnose diabetic ketoacidosis (DKA) and classify its severity in children with new-onset diabetes mellitus (NODM). METHODS:Retrospective study of all patients with NODM presenting to Boston Children's Hospital from October 1, 2007, to July 1, 2013. DKA was defined as blood glucose $200 mg/dL, venous pH (vpH) ,7.3, and urine ketones $2+, and severe DKA as vpH ,7.1. Linear regression was used to assess serum HCO3 as a predictor of vpH, and logistic regression to evaluate serum HCO3 as a predictor of DKA and severe DKA.RESULTS: Of 690 study cohort subjects (47% girls, age 10.8 6 4.3 years, 76.7% white), 19.4% presented with DKA. The relationship between serum HCO3 and vpH was log-linear (r = 0.87, 95% CI 0.85-0.89, P , .001). HCO3 predicted vpH (R 2 0.75, P , .001) using the formula Diabetes mellitus in youth is common, with an estimated worldwide annual incidence of 80 000 children younger than 15 years 1 and the incidence is rising. 2 Diabetic ketoacidosis (DKA) at presentation of new-onset diabetes mellitus (NODM) occurs in approximately 15% to 70% of patients in Europe and North America. 3 The incidence of DKA at presentation is higher in younger children, ethnic minorities, families of lower socioeconomic status, and regions with a lower prevalence of diabetes, 3-7 which includes many resource-limited countries.In many pediatric academic medical centers in the United States, the standard initial diagnostic evaluation for children with NODM and especially those suspected to have DKA includes a panel of laboratory tests to measure venous blood gas (VBG) and the concentrations of plasma glucose, serum electrolytes, serum bicarbonate (HCO3), serum urea nitrogen (SUN), creatinine, hemoglobin A1c (HbA1c), and serum or urinary ketones. Acidemia is defined as arterial pH ,7.35 or venous pH (vpH) ,7.3, and traditionally, a vpH ,7.3 or a serum HCO3 ,15 mmol/L is used to confirm the diagnosis of DKA, with lower values of both indicating greater severity of the condition. Venous pH ,7.1 or serum HCO3 ,5 mmol/L has been used to define severe DKA. 3,8 These definitions are incorporated into hospital practice guidelines, and emergency department physicians and pediatricians often base management decisions, for example, admission to hospital and use of intravenous versus subcutaneous insulin therapy, on the vpH value. However, in remote or limited resource settings, VBG is not readily available.A recent study of pediatric patients seen in an emergency department suggested that the venous HCO3 concentration accurately predicts abnormal vpH in children with DKA. 9 Similarly, in adults, venous HCO3 concentrations predicted arterial pH with a high degree of sensitivity and specificity. 10 The objective of our study was to evaluate the ability of serum HCO3, measured at presentation, as part of a routine basic metabolic panel, to accurately predict DKA and classify its severity in a large population of youth with NODM. METHODS Stu...

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Section: Discussionmentioning

confidence: 99%

Use of Serum Bicarbonate to Substitute for Venous pH in New-Onset Diabetes

Oettingen¹,

Wolfsdorf

Feldman

et al. 2015

Pediatrics

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“…Continuous noninvasive capnography to measure endtidal CO 2 is suggested to correlate well with the degree of acidosis in DKA; the resolution of ketoacidosis is evident in form of steady increment of ETCO 2 towards normal range (35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45) [56].…”

Section: Monitoringmentioning

confidence: 99%

Management of Diabetic Ketoacidosis

et al. 2010

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Diabetic ketoacidosis (DKA), a life-threatening complication of diabetes mellitus (DM), occurs more commonly in children with type 1 DM than type 2 DM. Hyperglycemia, metabolic acidosis, ketonemia, dehydration and various electrolyte abnormalities result from a relative or absolute deficiency of insulin with or without an excess of counter-regulatory hormones. Management requires careful replacement of fluid and electrolyte deficits, intravenous administration of insulin, and close monitoring of clinical and biochemical parameters directed towards timely detection of complications, including hypokalemia, hypoglycemia and cerebral edema. Cerebral edema may be life threatening and is managed with fluid restriction, administration of mannitol and ventilatory support as required. Factors precipitating the episode of DKA should be identified and rectified. Following resolution of ketoacidosis, intravenous insulin is transitioned to subcutaneous route, titrating dose to achieve normoglycemia.

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“…Patients suffering from conditions such as diabetic ketoacidosis and congenital lactic acidosis display changes in blood pH levels, which must be monitored for proper treatment. 2,3 Diabetics are urged to test their blood glucose levels multiple times per day. 4,5 Thus, there is a critical need to develop a sensing platform that will enable such measurements directly in the vasculature.…”

Section: Blood Analyte Monitoringmentioning

confidence: 99%

Blood analyte sensing using fluorescent dye-loaded red blood cells

et al. 2014

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Measurement of blood analytes provides crucial information about a patient's health. Some such analytes, such as glucose in the case of diabetes, require long-term or near-continuous monitoring for proper disease management. However, current monitoring techniques are far from ideal: multiple-per-day finger stick tests are inconvenient and painful for the patient; implantable sensors have short functional life spans (i.e., 3-7 days). Due to analyte transporters on red blood cell (RBC) membranes that equilibrate intracellular and extracellular analyte levels, RBCs serve as an attractive alternative for encapsulating analyte sensors. Once reintroduced to the blood stream, the functionalized RBCs may continue to live for the remainder of their life span (120 days for humans). They are biodegradable and biocompatible, thereby eliminating the immune system response common for many implanted devices. The proposed sensing system utilizes the ability of the RBCs to swell in response to a decrease in the osmolarity of the extracellular solution. Just before lysis, they develop small pores on the scale of tens of nanometers. While at low temperature, analyte-sensitive dyes in the extracellular solution diffuse into the perforated RBCs and become entrapped upon restoration of temperature and osmolarity. Since the fluorescent signal from the entrapped dye reports on changes in the analyte level of the extracellular solution via the RBC transporters, interactions between the RBCs and the dye are critical to the efficacy of this technique. In this work, we study the use of a near infrared pH sensitive dye encapsulated within RBCs and assess the ability to measure dye fluorescence in vivo.

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Continuous non-invasive end-tidal CO2 monitoring in pediatric inpatients with diabetic ketoacidosis

Cited by 35 publications

References 14 publications

Use of Serum Bicarbonate to Substitute for Venous pH in New-Onset Diabetes

Use of Serum Bicarbonate to Substitute for Venous pH in New-Onset Diabetes

Management of Diabetic Ketoacidosis

Blood analyte sensing using fluorescent dye-loaded red blood cells

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