(728) Diagnostic Accuracy and Clinical Utility of Venous Blood Analysis in Pediatric Diabetic Ketoacidosis

Introduction: Efficient management of Diabetic Ketoacidosis (DKA) in children necessitates timely diagnosis and close monitoring of chemical and biochemical parameters. Current DKA protocols involve collecting a serum chemistry panel and a venous blood gas (VBG) simultaneously. Recent technological advancements have now made it possible to obtain electrolyte and pH measurements from a single venous blood gas sample. Previous research has been limited to the adult cohort. Hence our study aims to assess the accuracy of VBG electrolytes using serum chemistry electrolytes as standard criteria in diagnosing DKA in an urban pediatric emergency department (PED).

Methods: We conducted a retrospective chart review to identify patients under the age of 18 years who visited Elmhurst Hospital's PED between April 1, 2016, and July 31, 2022 with an ICD-10 diagnosis code for hyperglycemia (glucose >250 mg/dL). Of this, we identified two groups: one meeting the criteria for DKA according to the American Diabetes Association (blood glucose >250mg/dL, venous pH < 7.3, serum bicarbonate < 18 mEq/L, serum anion gap >10 mEq/L and presence of ketones in blood or urine) and the other with glucose levels >250 mg/dL but not meeting DKA criteria. Data was analyzed using SPSS v28.0, comparing accuracy of VBG electrolytes against serum using the following metrics: sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV) and Pearson's correlation coefficients for serum and VBG electrolytes.

Results: 79 charts of patients with hyperglycemia were analysed, of which 52 patients (mean age 13 years, 52% female) met the criteria for DKA. VBG electrolytes were found to have a sensitivity of 87.3% (CI=78.1- 96.4) and a specificity of 98.2% (CI=93.1-100) for diagnosing DKA. Correlation coefficients between VBG and serum chemistry for sodium, potassium and bicarbonate were 0.5(p < 0.0005), 0.9(p < 0.0001), 0.9(p < 0.0001). PPV was 98% (CI=95.8-100) and NPV was 80.9% (CI=67.6-94.1).

Conclusions: Our findings suggest that VBG electrolytes show promising accuracy in diagnosing DKA in PED. This approach can aid in quick identification of patients suspected to have DKA with faster turnaround time, lower cost when used alone and reduced need for additional blood samples thereby facilitating prompt treatment.