Transcutaneous carbon dioxide monitoring during diabetic ketoacidosis in children and adolescents

Mary E. McBride, John W. Berkenbosch, Joseph D. Tobias*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

15 Scopus citations

Abstract

Objective: Our aim was to evaluate the utility of transcutaneous CO 2 (TC-CO2) monitoring in following the response to therapy in children and adolescents in diabetic ketoacidosis (DKA) requiring ICU admission. Methods: During therapy for DKA, TC-CO2 was monitored and compared with the serum bicarbonate values (HCO3-). As clinically indicated, serum electrolytes including serum HCO3 - were drawn and at the same time, the TC-CO2 value was recorded. Using the TC-CO2 value and the equation (PaCO2 = 1.5 x HCO3- + 8), a calculated HCO3 - value was determined. The measured serum HCO3 - value was subtracted from the calculated HCO3 - value and the absolute difference was recorded. The difference between the measured serum HCO3- and the calculated HCO3- was analysed using analysis of variance after stratification for serum HCO3- values and patient age ranges. Calculated to serum HCO3- values were compared using linear regression analysis. In addition, serum HCO3 - values were plotted against TC-CO2 values to derive an equation from these data which would relate the TC-CO2 values to the measured serum HCO3-. 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-CO2 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 HCO3 - value or patient's age. Linear regression analysis of calculated HCO3- against serum HCO3- revealed a slope of 0.95 and an r2 value of 0.88. Linear regression analysis using serum HCO3- against TC-CO2 resulted in the following equations: TC-CO2 = (1.64 × HCO3 -) + 3.9 or HCO3- = 0.61 × (TC-CO 2 - 3.9). Conclusions: TC-CO2 correlates with serum HCO3- and can be used to follow therapy in children and adolescents in DKA.

Original languageEnglish (US)
Pages (from-to)167-171
Number of pages5
JournalPaediatric anaesthesia
Volume14
Issue number2
DOIs
StatePublished - 2004

Keywords

  • Diabetic ketoacidosis
  • Non-invasive monitoring
  • Transcutaneous carbon dioxide

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Anesthesiology and Pain Medicine

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