End-tidal Carbon Dioxide Predicts the Presence and Severity of Acidosis in Children with Diabetes

Fearon, Deirdre M.; Steele, Dale W.

doi:10.1111/j.1553-2712.2002.tb01605.x

Cited by 36 publications

(25 citation statements)

References 9 publications

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“…Numerous studies have evaluated the relationship between acidosis and ETCO 2, most of which are in the pediatric patients or the patients without DKA 11–15. In the current study, we aimed to evaluate the relationship between blood bicarbonate and end-tidal carbon dioxide (ETCO 2 ) values and the predictive value of ETCO 2 in DKA diagnosis in adult patients with increased blood sugar levels referred to the ED.…”

Section: Introductionmentioning

confidence: 99%

Predictive Value of Capnography for Suspected Diabetic Ketoacidosis in the Emergency Department

Soleimanpour¹,

Taghizadieh²,

Niafar³

et al. 2013

WestJEM

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Introduction:Metabolic acidosis confirmed by arterial blood gas (ABG) analysis is one of the diagnostic criteria for diabetic ketoacidosis (DKA). Given the direct relationship between end-tidal carbon dioxide (ETCO2), arterial carbon dioxide (PaCO2), and metabolic acidosis, measuring ETCO2 may serve as a surrogate for ABG in the assessment of possible DKA. The current study focuses on the predictive value of capnography in diagnosing DKA in patients referring to the emergency department (ED) with increased blood sugar levels and probable diagnosis of DKA.Methods:In a cross-sectional prospective descriptive-analytic study carried out in an ED, we studied 181 patients older than 18 years old with blood sugar levels of higher than 250 mg/dl and probable DKA. ABG and capnography were obtained from all patients. To determine predictive value, sensitivity, specificity and cut-off points, we developed receiver operating characteristic curves.Results:Sixty-two of 181 patients suffered from DKA. We observed significant differences between both groups (DKA and non-DKA) regarding age, pH, blood bicarbonate, PaCO2 and ETco2 values (p≤0.001). Finally, capnography values more than 24.5 mmHg could rule out the DKA diagnosis with a sensitivity and specificity of 0.90.Conclusion:Capnography values greater than 24.5 mmHg accurately allow the exclusion of DKA in ED patients suspected of that diagnosis. Capnography levels lower that 24.5 mmHg were unable to differentiate between DKA and other disease entities.

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Section: Introductionmentioning

confidence: 99%

Predictive Value of Capnography for Suspected Diabetic Ketoacidosis in the Emergency Department

Soleimanpour¹,

Taghizadieh²,

Niafar³

et al. 2013

WestJEM

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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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“…In patients with metabolic acidosis, compensatory hyperventilation reduces plasma carbon dioxide and consequently plasma bicarbonate. In most of these patients, the decrease in plasma bicarbonate concentration may be predicted from the arterial pCO 2 by the Winter's equation [16, 17]. …”

Section: Physiological Relationship Between Carbon Dioxide and Plamentioning

confidence: 99%

“…Accordingly, end-tidal pCO 2 monitoring may be used as surrogate for arterial pCO 2 and prevent from cumbersome arterial blood gases extraction [18]. In addition, end-tidal pCO 2 is correlated with serum bicarbonate level and capnography has been used as noninvasive accurate estimate of plasma bicarbonate concentration in patients with diabetic ketoacidosis [17, 20], among children with gastroenteritis [21], and in patients presenting to the emergency department [22]. In children with gastroenteritis, end-tidal pCO 2 values greater than 34 mmHg ruled out plasma bicarbonate concentration lower than 15 mmol/L [21].…”

Section: Physiological Relationship Between Carbon Dioxide and Plamentioning

confidence: 99%

The Importance of the Ionic Product for Water to Understand the Physiology of the Acid-Base Balance in Humans

Adeva‐Andany¹,

Carneiro-Freire²,

Donapetry‐García³

et al. 2014

BioMed Research International

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Human plasma is an aqueous solution that has to abide by chemical rules such as the principle of electrical neutrality and the constancy of the ionic product for water. These rules define the acid-base balance in the human body. According to the electroneutrality principle, plasma has to be electrically neutral and the sum of its cations equals the sum of its anions. In addition, the ionic product for water has to be constant. Therefore, the plasma concentration of hydrogen ions depends on the plasma ionic composition. Variations in the concentration of plasma ions that alter the relative proportion of anions and cations predictably lead to a change in the plasma concentration of hydrogen ions by driving adaptive adjustments in water ionization that allow plasma electroneutrality while maintaining constant the ionic product for water. The accumulation of plasma anions out of proportion of cations induces an electrical imbalance compensated by a fall of hydroxide ions that brings about a rise in hydrogen ions (acidosis). By contrast, the deficiency of chloride relative to sodium generates plasma alkalosis by increasing hydroxide ions. The adjustment of plasma bicarbonate concentration to these changes is an important compensatory mechanism that protects plasma pH from severe deviations.

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End-tidal Carbon Dioxide Predicts the Presence and Severity of Acidosis in Children with Diabetes

Abstract: End-tidal CO(2) is linearly related to HCO(3) and is significantly lower in children with DKA. If confirmed by larger trials, cut-points of 29 torr and 36 torr, in conjunction with clinical assessment, may help discriminate between patients with and without DKA, respectively.

Cited by 36 publications

References 9 publications

Predictive Value of Capnography for Suspected Diabetic Ketoacidosis in the Emergency Department

Predictive Value of Capnography for Suspected Diabetic Ketoacidosis in the Emergency Department

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

The Importance of the Ionic Product for Water to Understand the Physiology of the Acid-Base Balance in Humans

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