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

Abstract

Background: Patients with diabetic ketoacidosis (DKA) hyperventilate, lowering their alveolar (PACO 2 ) and arterial carbon dioxide (PaCO 2 ). This ventilatory response lessens the severity of their acidemia in a predictable way. Because end-tidal CO 2 (ETCO 2 ) closely approximates PaCO 2 , measured ETCO 2 levels should allow for predictions about the presence and severity of acidosis in diabetic patients. Objectives: 1) To evaluate the relationship between measured serum bicarbonate (HCO 3 ) and ETCO 2 measured via nasal capnography in children with suspected DKA; and 2) to assess the ability of capnography to predict DKA. Methods: Children being evaluated in a pediatric emergency department for suspected DKA (known or suspected diabetes presenting with hyperglycemia with or without ketonuria) were enrolled in a cross-sectional, prospective, observational study. Prior to the availability of venous HCO 3 results, ETCO 2 values were measured using a Nellcor NPB-70 Handheld Capnograph. Results: Forty-two patients were

Evaluation of end-tidal carbon dioxide role in predicting elevated SOFA scores and lactic acidosis

“…Prior studies have examined the utility of ETCO2 to assess acidosis [7][8][9], pre-hospital trauma [4], and ventilation during procedural sedation [10]. Given our limited sample size, we did not search for the optimal thresholds, instead we relied upon previously defined cut-offs.…”

Current Utilization of Continuous End-Tidal Carbon Dioxide Monitoring in Pediatric Emergency Departments

“…Therefore, it is also helpful in managing conditions such as diabetic ketoacidosis and dehydration. 3,4 Fearon and Steele 3 demonstrated a linear relationship between ETCO 2 measurements and serum bicarbonate levels in children with diabetes. ETCO 2 was shown to correlate with the severity of metabolic acidosis and thus acted as a predictor of diabetic ketoacidosis in comparison to hyperglycemia.…”

“…2 Recent studies have also used it to measure metabolic disturbances. 3,4 It has been shown, however, that continuous ETCO 2 monitoring is underutilized by physicians in pediatric and adult intensive care units abroad and physicians in adult emergency departments and emergency medical service personnel in the United States. 5Y8 This is the first study to investigate how ETCO 2 monitoring is being used by pediatric emergency medicine (PEM) physicians.…”

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“…Using the relationship between PaCO 2 and PetCO 2 , a recent study [46] showed a linear relationship between PetCO 2 and serum bicarbonate with a sensitivity of 0.83 and specificity of 1.0 in patients with diabetic ketoacidosis. PetCO 2 is a helpful noninvasive adjunct for monitoring critically ill patients and for guiding therapy.…”