{"title":"Capnography as a tool for triaging and diagnosis of diabetic ketoacidosis in the emergency department: A prospective observational study.","authors":"Suhrith Bhattaram, Varsha Sambhaji Shinde, Princy Panthoi Khumujam, Anjeeth Puthoor Anilkumar, Dhruva Kumar Reddy","doi":"10.4103/tjem.tjem_15_23","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>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<sub>2</sub>), blood pH, and EtCO<sub>2</sub> bicarbonate levels was analyzed. The predictive value of EtCO<sub>2</sub> was also analyzed in the diagnosis of DKA. Finally, we aimed to determine the value of EtCO<sub>2</sub> as a screening test for the exclusion of DKA.</p><p><strong>Materials and methods: </strong>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<sub>2</sub> analysis.</p><p><strong>Results: </strong>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<sub>2</sub> ≤24 was determined to rule in DKA with a sensitivity of 93.02% and specificity of 91.9%. EtCO<sub>2</sub> >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<sub>2</sub> (<i>P</i> < 0.0001, <i>r</i> = 0.82) and HCO3 and EtCO<sub>2</sub> (<i>r</i> = 0.896, <i>P</i> < 0.0001) was found.</p><p><strong>Conclusions: </strong>EtCO<sub>2</sub> 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<sub>2</sub> values >26 can be an effective triaging tool for ruling our DKA. A significant linear correlation between pH and EtCO<sub>2</sub> and pH and HCO3 was observed. EtCO<sub>2</sub> can be considered a surrogate marker for the degree of response to the treatment in DKA.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.1000,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6b/15/TJEM-23-169.PMC10389092.pdf","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Turkish Journal of Emergency Medicine","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.4103/tjem.tjem_15_23","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"EMERGENCY MEDICINE","Score":null,"Total":0}
引用次数: 0
Abstract
Objectives: 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 (EtCO2), blood pH, and EtCO2 bicarbonate levels was analyzed. The predictive value of EtCO2 was also analyzed in the diagnosis of DKA. Finally, we aimed to determine the value of EtCO2 as a screening test for the exclusion of DKA.
Materials and methods: 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 EtCO2 analysis.
Results: 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 EtCO2 ≤24 was determined to rule in DKA with a sensitivity of 93.02% and specificity of 91.9%. EtCO2 >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 EtCO2 (P < 0.0001, r = 0.82) and HCO3 and EtCO2 (r = 0.896, P < 0.0001) was found.
Conclusions: EtCO2 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. EtCO2 values >26 can be an effective triaging tool for ruling our DKA. A significant linear correlation between pH and EtCO2 and pH and HCO3 was observed. EtCO2 can be considered a surrogate marker for the degree of response to the treatment in DKA.
期刊介绍：
The Turkish Journal of Emergency Medicine (Turk J Emerg Med) is an International, peer-reviewed, open-access journal that publishes clinical and experimental trials, case reports, invited reviews, case images, letters to the Editor, and interesting research conducted in all fields of Emergency Medicine. The Journal is the official scientific publication of the Emergency Medicine Association of Turkey (EMAT) and is printed four times a year, in January, April, July and October. The language of the journal is English. The Journal is based on independent and unbiased double-blinded peer-reviewed principles. Only unpublished papers that are not under review for publication elsewhere can be submitted. The authors are responsible for the scientific content of the material to be published. The Turkish Journal of Emergency Medicine reserves the right to request any research materials on which the paper is based. The Editorial Board of the Turkish Journal of Emergency Medicine and the Publisher adheres to the principles of the International Council of Medical Journal Editors, the World Association of Medical Editors, the Council of Science Editors, the Committee on Publication Ethics, the US National Library of Medicine, the US Office of Research Integrity, the European Association of Science Editors, and the International Society of Managing and Technical Editors.
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