Bhattaram Suhrith, Shinde Varsha Sambhaji, Khumujam Princy Panthoi, Anilkumar Anjeeth Puthoor, Reddy Dhruva Kumar
Department of Emergency Medicine, Dr. D.Y. Patil Medical College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India.
Department of Obstetrics and Gynaecology, NEIGHRIMS, Shillong, Meghalaya, India.
Turk J Emerg Med. 2023 Jun 26;23(3):169-175. doi: 10.4103/tjem.tjem_15_23. eCollection 2023 Jul-Sep.
The cornerstone of management of acidosis in a patient with diabetic ketoacidosis (DKA) has traditionally been carried out by blood gas analysis, which is expensive and associated with significant risk. It is against this background that the correlation between end-tidal carbon dioxide (EtCO), blood pH, and EtCO bicarbonate levels was analyzed. The predictive value of EtCO was also analyzed in the diagnosis of DKA. Finally, we aimed to determine the value of EtCO as a screening test for the exclusion of DKA.
This was a prospective cohort study carried out in the emergency department of a tertiary care teaching hospital from September 2020 to September 2021. Patients with suspected DKA underwent simultaneous blood gas collection and EtCO analysis.
A total of 123 patients with blood sugar levels >250 mg/dl and moderate-to-large (≥2+) urine ketones were studied. A cut-off value of EtCO ≤24 was determined to rule in DKA with a sensitivity of 93.02% and specificity of 91.9%. EtCO >26 could effectively rule out the diagnosis of DKA with sensitivity of 98.8% and specificity of 75.7%. A significant linear correlation between pH and EtCO ( < 0.0001, = 0.82) and HCO3 and EtCO ( = 0.896, < 0.0001) was found.
EtCO values ≤24 can accurately identify patients with DKA in the presence of elevated blood sugar and urinary ketones and must be considered a valuable addition to the diagnostic criteria. EtCO values >26 can be an effective triaging tool for ruling our DKA. A significant linear correlation between pH and EtCO and pH and HCO3 was observed. EtCO can be considered a surrogate marker for the degree of response to the treatment in DKA.
传统上，糖尿病酮症酸中毒（DKA）患者酸中毒管理的基石是通过血气分析来进行，这既昂贵又存在重大风险。正是在这种背景下，分析了呼气末二氧化碳（EtCO）、血液pH值和EtCO碳酸氢盐水平之间的相关性。还分析了EtCO在DKA诊断中的预测价值。最后，我们旨在确定EtCO作为排除DKA的筛查试验的价值。
这是一项前瞻性队列研究，于2020年9月至2021年9月在一家三级护理教学医院的急诊科进行。疑似DKA的患者同时进行了血气采集和EtCO分析。
共研究了123例血糖水平>250mg/dl且尿酮体为中度至大量（≥2+）的患者。确定EtCO≤24的临界值用于诊断DKA，敏感性为93.02%，特异性为91.9%。EtCO>26可有效排除DKA诊断，敏感性为98.8%，特异性为75.7%。发现pH值与EtCO之间存在显著线性相关性（<0.0001，=0.82）以及HCO3与EtCO之间存在显著线性相关性（=0.896，<0.0001）。
在血糖和尿酮体升高的情况下，EtCO值≤24可准确识别DKA患者，必须将其视为诊断标准中有价值的补充。EtCO值>26可作为排除DKA的有效分诊工具。观察到pH值与EtCO以及pH值与HCO3之间存在显著线性相关性。EtCO可被视为DKA治疗反应程度的替代标志物。
