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Utilizing End-Tidal Carbon Dioxide to Diagnose Diabetic Ketoacidosis in Prehospital Patients with Hyperglycemia

Published online by Cambridge University Press:  15 April 2020

Christopher Hunter Open the ORCID record for Christopher Hunter [Opens in a new window] ,
Monty Putman ,
Jermaine Foster ,
Amy Souers ,
Alexa Rodriguez ,
Christian Zuver  and
Linda Papa
Christopher Hunter*
Affiliation:
Orlando Health Department of Emergency Medicine, Orlando, FloridaUSA
Monty Putman
Affiliation:
Orlando Health Department of Emergency Medicine, Orlando, FloridaUSA
Jermaine Foster
Affiliation:
Orlando Health Department of Emergency Medicine, Orlando, FloridaUSA
Amy Souers
Affiliation:
Orlando Health Department of Emergency Medicine, Orlando, FloridaUSA
Alexa Rodriguez
Affiliation:
Orlando Health Department of Emergency Medicine, Orlando, FloridaUSA
Christian Zuver
Affiliation:
Orlando Health Department of Emergency Medicine, Orlando, FloridaUSA
Linda Papa
Affiliation:
Orlando Health Department of Emergency Medicine, Orlando, FloridaUSA
*
Correspondence: Christopher Hunter, MD, PhD, Orlando Health Department of Emergency Medicine, 86 W. Underwood Street, Suite 200, MP 31, Orlando, Florida32806USA, E-mail: dr.chrishunter@gmail.com
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Abstract

Background:

Early identification of diabetic ketoacidosis (DKA) may improve clinical outcomes. Prior studies suggest exhaled end tidal carbon dioxide (ETCO2) provides a non-invasive, real-time method to screen for DKA in the emergency department (ED).

Methods:

This a retrospective cohort study among patients who activated Emergency Medical Services (EMS) during a one-year period. Initial out-of-hospital vital signs documented by EMS personnel, including ETCO2 and first recorded blood glucose level (BGL), as well as in-hospital records, including laboratory values and diagnosis, were collected. The main outcome was the association between ETCO2 and the diagnosis of DKA.

Results:

Of the 118 patients transported with hyperglycemia (defined by BGL >200), six (5%) were diagnosed with DKA. The mean level of ETCO2 in those without DKA was 35mmHg (95% CI, 33-38mmHg) compared to mean levels of 15mmHg (95% CI, 8-21mmHg) in those with DKA (P <.001). The Area Under the Receiver Operating Characteristics (ROC) Curve (AUC) for ETCO2 identifying DKA was 0.96 (95% CI, 0.92-1.00). The correlation coefficient between ETCO2 and serum bicarbonate (HCO3) was 0.436 (P <.001) and the correlation coefficient between ETCO2 and anion gap was -0.397 (P <.001).

Conclusion:

Among patients with hyperglycemia, prehospital levels of ETCO2 were significantly lower in patients with DKA compared to those without and were predictive of the diagnosis of DKA. Furthermore, out-of-hospital ETCO2 was significantly correlated with measures of metabolic acidosis.

Keywords

DKAETCO2prehospital
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 35 , Issue 3 , June 2020 , pp. 281 - 284
Copyright
© World Association for Disaster and Emergency Medicine 2020

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