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Venous blood gas in adult patients with diabetic ketoacidosis
  1. Ziauddin Hassan, Registrars,
  2. Devasena M Subramonyam, Registrars,
  3. Shobhan Thakore, Specialist Registrar
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; kevin.mackway-jones:man.ac.uk

    Abstract

    A short cut review was carried out to establish whether venous blood gas measurement accurately demonstrates the degree of acidosis in patients with diabetic ketoacidosis. A total of 27 papers were found using the reported search, of which two presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.

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    Report by Ziauddin Hassan, Devasena M Subramonyam,RegistrarsChecked by Shobhan Thakore, Specialist Registrar

    Clinical scenario

    A 22 year old insulin dependent diabetic presents to our emergency department with a raised blood sugar and urine dipstick showing +++ of ketones. You suspect diabetic ketoacidosis and would like the know the degree of his acidosis, but the patient refuses arterial blood gas sampling due to a previous bad experience. You wonder whether venous blood would accurately show the degree of his metabolic acidosis.

    Three part question

    In [an adult patient with diabetic ketoacidosis] do [venous blood gases] accurately demonstrate [the degree of acidosis]?

    Search strategy

    Medline 1966–04/03 using the OVID interface. [(venous blood.mp OR exp blood specimen collection OR exp blood gas analysis) AND (exp diabetic ketoacidosis OR diabetic ketoacidosis.mp OR exp diabetic coma) AND (exp acidosis OR acidosis.mp OR exp hydrogen-ion concentration)] AND LIMIT to human AND English language.

    Search outcome

    Altogether 27 papers were found of which only two are relevant and of sufficient quality for inclusion (table 2).

    Table 2

    Comment(s)

    There are only a limited number of studies on this subject and these have involved small numbers of patients. Further studies with large series of patients are necessary.

    CLINICAL BOTTOM LINE

    There is no clinically significant difference between arterial and venous pH estimates in patients with diabetic ketoacidosis.

    Report by Ziauddin Hassan, Devasena M Subramonyam,RegistrarsChecked by Shobhan Thakore, Specialist Registrar

    References

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