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BMC Emergency Medicine

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Open Access 01-12-2016 | Research article

Diagnostic value of end tidal capnography in patients with hyperglycemia in the emergency department

Authors: Ralphe Bou Chebl, Bryan Madden, Justin Belsky, Elie Harmouche, Lenar Yessayan

Published in: BMC Emergency Medicine | Issue 1/2016

Abstract

Background

Diabetic Ketoacidosis (DKA) is a potentially life-threatening emergency that requires prompt diagnosis and treatment. In paediatric populations an end tidal capnography value greater than 36 mmHg was found to be 100 % sensitive in ruling out DKA.

Methods

A cross sectional observational study of adults ≥ 17 years of age presenting to the emergency department between January 2014 and May 2014 with glucose > 550 mg/dL. In all patients, nasal capnography and venous blood gas analysis were performed prior to any insulin or intravenous fluid administration. The diagnosis of DKA was based on the presence of anion gap metabolic acidosis, hyperglycaemia and ketonemia. The overall diagnostic performance (area under the curve [AUC]), sensitivity, specificity and likelihood ratios at different end tidal CO₂ (ETCO₂) cut-offs were determined.

Results

71 patients were enrolled in the study of which 21 (30 %) met the diagnosis of DKA. The area under the curve for ETCO₂ was 0.95 with a 95 % CI of 0.91 to 0.99. Test sensitivity for DKA at ETCO₂ level ≥35 mmHg was 100 % (95 % CI, 83.9–100). An ETCO₂ level ≤ 21 mmHg was 100 % specific (95 % CI, 92.9–100.0) for DKA.

Conclusion

Nasal capnography exhibits favourable diagnostic performance in detecting patients with or without DKA among those who present to the emergency department with a glucometer reading > 550 mg/dL.

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Title: Diagnostic value of end tidal capnography in patients with hyperglycemia in the emergency department
Authors: Ralphe Bou Chebl
Bryan Madden
Justin Belsky
Elie Harmouche
Lenar Yessayan
Publication date: 01-12-2016
Publisher: BioMed Central
Published in: BMC Emergency Medicine / Issue 1/2016
Electronic ISSN: 1471-227X
DOI: https://doi.org/10.1186/s12873-016-0072-7

At a glance: The STEP trials

Springer Medicine

Diagnostic value of end tidal capnography in patients with hyperglycemia in the emergency department

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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