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Transcutaneous carbon dioxide monitoring during diabetic ketoacidosis in children and adolescents
Author(s) -
McBride Mary E.,
Berkenbosch John W.,
Tobias Joseph D.
Publication year - 2004
Publication title -
pediatric anesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.704
H-Index - 82
eISSN - 1460-9592
pISSN - 1155-5645
DOI - 10.1046/j.1460-9592.2003.01176.x
Subject(s) - medicine , diabetic ketoacidosis , bicarbonate , anion gap , gastroenterology , carbon dioxide , anesthesia , metabolic acidosis , insulin , ecology , biology
Summary Objective : Our aim was to evaluate the utility of transcutaneous CO 2 (TC‐CO 2 ) monitoring in following the response to therapy in children and adolescents in diabetic ketoacidosis (DKA) requiring ICU admission. Methods : During therapy for DKA, TC‐CO 2 was monitored and compared with the serum bicarbonate values (HCO 3 − ). As clinically indicated, serum electrolytes including serum HCO 3 − were drawn and at the same time, the TC‐CO 2 value was recorded. Using the TC‐CO 2 value and the equation (PaCO 2 = 1.5 × HCO 3 − + 8), a calculated HCO 3 − value was determined. The measured serum HCO 3 − value was subtracted from the calculated HCO 3 − value and the absolute difference was recorded. The difference between the measured serum HCO 3 − and the calculated HCO 3 − was analysed using analysis of variance after stratification for serum HCO 3 − values and patient age ranges. Calculated to serum HCO 3 − values were compared using linear regression analysis. In addition, serum HCO 3 − values were plotted against TC‐CO 2 values to derive an equation from these data which would relate the TC‐CO 2 values to the measured serum HCO 3 − . Results : The cohort included 28 patients ranging in age from 1.6 to 21 years (9.4 ± 4.7 years) and in weight from 13 to 96 kg (35.6 ± 18.2 kg). Two additional patients were not included as the initial TC‐CO 2 values were inaccurate because of tissue hypoperfusion. In the remaining 28 patients, the absolute difference between the calculated bicarbonate and serum bicarbonate values was 1.5 ± 1.2 mmol·l −1 . The difference was ≤2 mol·l in 74.4% of samples and ≤5 mmol·l −1 in 99.2%. No difference in the value between the calculated and measured serum HCO 3 − was present according to serum HCO 3 − value or patient's age. Linear regression analysis of calculated HCO 3 − against serum HCO 3 − revealed a slope of 0.95 and an r 2 value of 0.88. Linear regression analysis using serum HCO 3 − against TC‐CO 2 resulted in the following equations:Conclusions : TC‐CO 2 correlates with serum HCO 3 − and can be used to follow therapy in children and adolescents in DKA.