The Value Of End-tidal Carbon Dioxide Partial Pressure In The Diagnosis Of Emergency Patients With Diabetic Ketoacidosis And The Clinical Analysis Of The Correlation Between The Severity Of Acidosis

Objective:This study was designed to evaluate the pre-diagnosis value of ETCO2 in patients with DKA and to elucidate the relationship between ETCO2 and pH,PaCO2,and bicarbonate.Methods:A cross-sectional observational study carried out in the emergency department,the experimental group included high-risk patients with DKA,and the control group was an emergency general patient who required ABG examination.The receiver operator characteristic curve(ROC)was used to determine the ETCO2 threshold and to determine its pre-diagnosis value for DKA patients.Results:Of the 53 patients,26 were DKA patients(49%).There were significant differences in pH,PaC02,blood bicarbonate,blood glucose,and ETCO2 between the two groups(DKA group and non-DKA group)(P<0.001).The area under the DKA curve(AUC)was 0.989(95%CI,0.913-1.000).ETCO2≤27 mmHg can diagnose DKA with a specificity of 100%(95%CI,87.2-100.0).ETCO2≥32 mmHg can exclude DKA with a sensitivity of 100%(95%CI,86.8-100.0).There is a significant correlation between ETCO2 and PaCO2(r=0.946),ETCO2 and blood bicarbonate(r=0.876),ETCO2 and pH(r=0.627).Conclusion:ETCO2 has good pre-diagnosis value for patients with DKA in emergency.Objective:The correlation between ETCO2 and the severity of metabolic acidosis in patients with DKA was analyzed by continuous monitoring of ETCO25 and the consistency of ETCO2 and ABG in assessing the severity of metabolic acidosis in patients with DKA was elucidated.Methods:An observational study in the emergency department was performed in 26 patients with DKA.ETCO2 was continuously monitored during treatment and ETCO2 were recorded within half an hour of each ABG sample.The ABG was used as the gold standard to describe the ROC curve of the severity of ETC02 and metabolic acidosis.The relationship between ETCO2 and pH,PaCO2,and actual arterial bicarbonate was evaluated.Results:A total of 26 DKA patients,82 groups of observation data,59 groups were acidosis data,23 groups were non-acidosis data.The AUC value of ETCO2 for judging metabolic acidosis was 0.912(95%CI,0.829-0.963),P<0.001.ETCO2≤23mmHg can be judged to have metabolic acidosis(specificity is 100%),and ETCO2≥38mmHg can be judged as non-metabolic acidosis(sensitivity is 100%).The ROC curve of ETCO2 for assessing blood glucose status in DKA patients was not meaningful(AUC value 0.503,P=0.977).Overall,there was a significant correlation between ETCO2 and PaCO2(r=0.963,P=0.000),and ETCO2 with actual arterial bicarbonate(r=0.842,P=0.000).The consistency of ABG and ETCO2 are stable in assessing metabolic acidosis in patients with DKA.The mean differences between ETCO2 and PaCO2 is 3.66±2.02(SD),the 95%limits of agreement is 3.66 ± 3.93.Conclusion:ETCO2 is closely related to the severity of metabolic acidosis in patients with DKA and can assist ABG in guiding the treatment of patients with DKA.