‘’TO COMPARE DIFFERENT PARAMETER OF ABG AND VBG IN PATIENTS WITH KETOACIDOSIS CASES OF DIABETES’’

Main Article Content

Dr Ragini Tarole
Dr Pradeep Prajapati
Dr Divya
Dr Seema

Keywords

arterial blood gas, diabetic ketoacidosis

Abstract

Introduction- Diabetes mellitus is common endocrinopathy. It is a group of common metabolic disorder which share the phenotype of hyperglycemia. DKA is acute, severe disorder directly related to diabetes. DKA was formerly considered a hallmark of type 1 DM, but it also occurs in individuals with type 2 DM who can sometimes subsequently be treated with oral glucose-lowering agents. Performing a VBG rather than an ABG is particularly convenient in the ICU and in the emergency department, either peripherally or from a central venous line from which venous blood can be quickly drawn.


Aims and objectives- This is a prospective study, was conducted in Department of General Medicine, G.R. Medical College, Gwalior (M.P.) from Jan 2021 – Jun 2022. The main aim of the study is-


‘’To compare different parameter of ABG and VBG in patients with ketoacidosis cases of diabetes’’.


Methods and materials- This is a single center observational study. In this study, demographic, clinical and laboratory details were studied in patients presenting with diabetic ketoacidosis satisfying the study population criteria and the impact on the outcome was assessed. 96 patients who will be getting admitted in medical units at Jayarogya hospital and group were randomly selected as per the inclusion and exclusion criteria. Written informed consent will be obtained from each diabetic patients enrolled in the study.


All the dates will be entered in a data collection sheet in an Excel format and analysed using SPSS Software. Numerical values will be reported using mean and standard deviation or median. Categorical values will be reported using number and percentages. Probability value (p) value less than 0.05 was considered a statistically significant.


Results- Among the studied 97 patients, maximum cases belonged to the age group 41-60 years (n=34). Mean age of the study population was 40.53 years with standard deviation of 17.47 years. Out of studied 97 patients, 70 were male and 27 were female. In our study, most common clinical symptom was vomiting (found in 28.9% patients), followed by altered sensorium (24.7% each), while abdominal pain 22.7% and shortness of breath was found in 17.5 % patients respectively. Among the studied 97 patients,16 were having associated hypertension and 4 patients were having CAD, while only 2 patients were suffering from hypothyroidism. In our study, Type 1 DM patients were 43.3% while 56.7% were Type 2 DM. Among the patients 41.2% shown no ECG changes, while 50.5% shown sinus tachycardia and only 8.2% shown significant ECG changes with tall T waves in precordial leads. Among the studied 97 patients, 19.6% expired while 80.4% recovered. The mean value of Arterial pH is 7.24±0.07 and Arterial bicarbonates is 18.74±2.73. while mean Venous pH is 7.26±0.06 and Venous Bicarbonates is 19.58±2.67 in expired patients.


The mean value of Arterial pH is 7.25±0.07 and Arterial bicarbonates is 17.07±3.06 while mean Venous pH is 7.25±0.06 and Venous Bicarbonates is 18.07±3.04 in expired patients.


Conclusions- It was concluded that venous blood gas analysis has got advantages over arterial blood gas analysis like safety, fewer number of punctures, easy sampling, less painful, less invasive even though there are some reservations’ analysis safer alternative to ABG for determining acid base status reducing the need for frequent invasive arterial sampling.


This study suggests that VBG pH values very closely correlate with ABG pH values, which also shows VBG substitution for ABG.


Hence venous blood gas might be used as an ideal alternative to arterial blood gas in the initial management of patients in Diabetic Ketoacidosis.

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References

1. Zisquit J, Velasquez J, Nedeff N. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Apr 30, 2022. Allen Test. [PubMed]
2. Cowley NJ, Owen A, Bion JF. Interpreting arterial blood gas results. BMJ. 2013 Jan 16;346:f16. [PubMed]
3. Larkin BG, Zimmanck RJ. Interpreting Arterial Blood Gases Successfully. AORN J.2015 Oct; 102 (4):343-54; quiz 355-7. [PubMed]
4. Rogers KM, McCutcheon K. Four steps to interpreting arterial blood gases. J PerioperPract. 2015 Mar;25(3):46-52. [PubMed]
5. Romanski SO. Interpreting ABGs in four easy steps (continuing education credit). Nursing. 1986 Sep;16(9):58-64. [PubMed]
6. ARDS Definition Task Force. Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, Camporota L, Slutsky AS. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012 Jun 20;307(23):2526-33. [PubMed]
7. Pediatric Acute Lung Injury Consensus Conference Group. Pediatric acute respiratory distress syndrome: consensus recommendations from the Pediatric Acute Lung Injury Consensus Conference. PediatrCrit Care Med. 2015 Jun;16(5):428-39. [PMC free article] [PubMed]
8. Rawat M, Chandrasekharan PK, Williams A, Gugino S, Koenigsknecht C, Swartz D, Ma CX, Mathew B, Nair J, Lakshminrusimha S. Oxygen saturation index and severity of hypoxic respiratory failure. Neonatology. 2015;107(3):161-6. [PMC free article] [PubMed]
9. Kurt OK, Alpar S, Sipit T, Guven SF, Erturk H, Demirel MK, Korkmaz M, Hayran M, Kurt B. The diagnostic role of capnography in pulmonary embolism. Am J Emerg Med. 2010 May;28(4):460-[PubMed]
10. Davis MD, Walsh BK, Sittig SE, Restrepo RD. AARC clinical practice guideline: blood gas analysis and hemoximetry: 2013. Respir Care. 2013 Oct;58(10):1694-703. [PubMed]
11. Albert TJ, Swenson ER. Circumstances When Arterial Blood Gas Analysis Can Lead Us Astray. Respir Care. 2016 Jan;61(1):119-21
12. Muakkassa FF, Rutledge R, Fakhry SM, Meyer AA, Sheldon GF. ABGs and arterial lines: The relationship to unnecessarily drawn arterial blood gas samples. J Trauma. 1990;30:1087–
13. 93. [PubMed] [Google Scholar]
14. Guidelines for standards of care of patients with acute respiratory failure on mechanical ventilator support. Task Force on Guidelines; Society of Critical Care Medicine. Crit Care Med. 1991;19:275–8. [PubMed] [Google Scholar]
15. Barker WJ. Arterial puncture and cannulation. In: Roberts JR, Hedges JR, editors. Clinical Procedure in Emergency Medicine. 3rd ed. Philadelphia: WB Saunders; 1998. pp. 308–22. [Google Scholar]
16. Malinoski DJ, et al. Correlation of central venous and arterial blood gas measurement in mechanically ventilated trauma patients. Arch Surg. 2005;140:122–5. [PubMed] [Google Scholar]
17. Kelly AM, McAlpine R, Kyle E. Agreement between bicarbonate measured on arterial and venous blood gases. Emerg Med Australas. 2004;16:407–9. [PubMed] [Google Scholar]
18. Ma OJ, Rush MD, Godfrey MM, Gaddis G. Arterial blood gas results rarely influence emergency physician management of patients with suspected diabetic ketoacidosis. Acad Emerg Med. 2003;10:836–41. [PubMed] [Google Scholar]
19. Gokel Y, Paydas S, Koseoglu Z, Alparslan N, Seydaoglu G. Comparison of blood gas and acid-base measurements in arterial and venous blood samples in patients with uremic acidosis and diabetic ketoacidosis in the emergency room. Am J Nephrol. 2000;20:319–[PubMed] [Google Scholar]
20. Kelly AM, McAlpine R, Kyle E. Venous pH can safely replace arterial pH in the initial evaluation of patients in the emergency department. Emerg Med J. 2001;18:340–2. [PMC free article] [PubMed] [Google Scholar]
21. Middleton P, Kelly AM, Brown J, Robertson M. Agreement between arterial and central venous values for pH, bicarbonate, base excess, and lactate. Emerg Med J. 2006;23:622–4. [PMC free article] [PubMed] [Google Scholar
22. Johnston HL, Murphy R. Agreement between an arterial blood gas analyser and a venous blood analyser in the measurement of potassium in patients in cardiac arrest. Emerg Med J. 2005;22:269–71. [PMC free article] [PubMed] [Google Scholar]
23. Kelly AM, Kyle E, McAlpine R. Venous pCO2 and pH can be used to screen for significant hypercarbia in emergency patients with acute respiratory disease. J Emerg Med. 2002;22:15–9. [PubMed] [Google Scholar]
24. Rang LC, Murray HE, Wells GA, Macgougan CK. Can peripheral venous blood gases replace arterial blood gases in emergency department
25. Balasubramanyam, A., Zern, JW., Hyman, DJ., Pavlik, V. (1999). New profiles of diabetic ketoacidosis: Type 1 vs type 2 diabetes and the effect of ethnicity. Archives of Internal Medicine. 159(19):2317
26. Barski, L., Nevzorov, R., Jotkowitz, A., Rabaev, E., Zektser, M., Zeller, L. (2013). Comparison of Diabetic Ketoacidosis in Patientswith Type-1 and Type-2 Diabetes Mellitus. The American Journal of the Medical Sciences. 345(4):326-330. Cross Ref
27. Brandenburg, MA., Dire, DJ. (1998). Comparison of arterial and venous blood gas values in the initial emergency department evaluation of patients with diabetic ketoacidosis. Annals of Emergency Medicine. 31(4):459–65.CrossRef
28. Brashear, RE., Oei, TO., Rhodes, ML., Futty, DE., Hostetler, ML. (1979). Relationship between arterial and venous bicarbonate values. Archives of Internal Medicine. 139(4):440–2. CrossRef
29. Cashen, K., Petersen, T. (2019). Diabetic Ketoacidosis. Pediatrics in Review. 40(8): 412-420. CrossRef
30. Ellemann, K., Soerensen, JN., Pedersen, L., Edsberg, B., Andersen, OO. (1984). Epidemiology and treatment of diabetic ketoacidosis in a community population. Diabetes Care. 7(6):528–32. CrossRef
31. Farsani, SF., Brodovicz, K., Soleymanlou, N., Marquard, J., Wissinger, E., Mayes, BA. (2017). Incidence and prevalence of diabetic ketoacidosis (DKA) among adults with type 1 diabetes mellitus (T1D): a systematic literature review. BMJ Open. 7:e016587. CrossRef
32. Ganie, MA., Koul, S., Razvi, HA., Laway, BA., Zargar, AH. (2012). Hyperglycemic emergencies in Indian patients with diabetes mellitus on pilgrimage to Amarnathjiyatra. Indian Journal of Endocrinology and Metabolism. 16 (Suppl 1):S87–90. Cross Ref
33. Gokel, Y., Paydas, S., Koseoglu, Z., Alparslan, N., Seydaoglu, G. (2000). Comparison of Blood Gas and Acid-Base Measurements inArterial and Venous Blood Samples in Patients with Uremic Acidosis and Diabetic Ketoacidosis in the Emergency Room. American Journal of Nephrology. 20(4):319–323. CrossRef
34. Jameson, JL., Fauci, AS., Kasper, DL., Hauser, SL., Longo, DL., Loscalzo, J. (2018) Harrison’s principles of Internal Medicine. 20th ed. Shanahan JF, Davis KJ, editors. United States of America: McGraw- Hill Education: p2870–2872.
35. Kelly, A-M. (2006). The case for venous rather than arterial blood gases in diabetic ketoacidosis. Emergency Medicine Australas. 18(1):64–7. CrossRef
36. Kitabchi, AE., Wall, BM. (1995). Diabetic ketoacidosis. Medical Clinics of North America. 79(1):9–37. CrossRef
37. Lee, HK., Oh, YS., Chung, YH., Yoo, HJ., et al. (1987).
38. Epidemiological Characteristics of Ketoacidosis among Korean Diabetic patients. Journal of Korean Medical Science. 2(1):7–11. CrossRef
39. Lwanga, S., Lemeshow, S. (1991). Sample Size Determination in Health Studies. Geneva: World Health Organization. 1-30.
40. Mortensen, J. (1967). Clinical Sequelae from Arterial Needle Puncture, Cannulation, and Incision. Circulation. 35(6):1118–23. CrossRef
41. Puttanna, A., Padinjakara, RNK. (2014). Diabetic ketoacidosis in type 2 diabetes mellitus. Practical Diabetes. 31(4): 155–158. CrossRef
42. Roberts, JR., Custalow, CB., Thomsen, TW. (2017). Roberts and Hedges clinical procedures in emergency medicine and acute care. 7th Edition. Elsevier Saunders. p1541.Singh, V., Khatana, S., Gupta, P. (2013). Blood gas analysis for bedside diagnosis. National Journal of Maxillofacial 4(2):136–41. CrossRef
43. Trachtenbarg, DE. (2005). Diabetic Ketoacidosis. American Family Physician. 71(9):1705–14.
44. 21) Bissler J, Welch T, Loggie J Paradoxical hypertension in hypovolemic children. Pediatric Emergency Care 1991; 7: 350–2. [PubMed] [Google Scholar]
45. Glaser NS, Wootton-Gorges SL, Marcin JP, Buonocore MH, Dicarlo J, Neely EK et al. Mechanism of cerebral edema in children with diabetic ketoacidosis. J Pediatr. 2004;145:164–71. [PubMed] [Google Scholar]
46. Richarasanov SK, M.D. Dire DJ. Comparison of arterial and venous blood gas values in the initial emergency department evaluation of patients with diabetic ketoacidosis. Ann Emerg Med., April 2002; 31: 459-65.
47. Hatice Dulber G, lruPolat Melih B.Y. Comparison of Arterial and Venous Blood Gas Values in case of COPD with acute respiratory failure. 2004; 8(9): 936-944.
48. Richard Treger, Shariar Pirouz, Nader Kamagra. Compared central venous and arterial blood gas measurements in the ICU. 2004; 16: 407- 409.