ESPE Abstracts

Introduction: This retrospective study aim ed to assess the correlation between whole blood electrolytes measured by an arterial blood gas analyzer and serum electrolytes measured at a central laboratory, of patients with diabetic ketoacidosis (DKA).

Materials and Methods: Children (1-18 years old) with DKA, followed up at Aydın Adnan Menderes University Faculty of Medicine Hospital between January 2017 and August 2022, were examined. Venous blood gas glucose, sodium, and potassium values were compared with real-time serum results. The agreement between the results of the venous blood gas and serum samples was evaluated by Bland-Altman analysis.

Results: A total of 621 analysis results from 176 patients were evaluated. Among the patients, 52.3% (n = 92) were female, with a median age of 11.5 years (range 0.8-17.6). Evaluating the clinical features, 31.8% (n = 56) had mild, 42.6% (n = 75) had moderate, and 25.6% (n = 45) had severe DKA. There was no difference in DKA severity concerning age and gender (P >0.05). The median blood gas pH was 7.15 (range 6.78-7.30), with an average pCO2 of 24.9±7.7 mmHg and an average HCO3 of 10.6±3.4 mmol/L. Comparing blood gas and serum parameters from all measurements, potassium was 0.1 mmol/L lower (95% CI 0.1-0.2), sodium was 2.4 mmol/L higher (95% CI 2.1-2.7), adjusted sodium was 2.3 mmol/L higher (95% CI 2.0-2.6), and glucose was 7.9 mg/dL lower (95% CI 4.4-11.5) in venous blood gas samples. Blood gas glucose levels were 0.5 mg/dL (95% CI 1.7-2.3) lower than serum levels in cases where serum glucose levels were between 100-300 mg/dL (95% CI -0.2–3.1). Blood gas sodium levels were 2.0 mmol/L (95% CI 1.7-2.3) higher than serum levels in cases where serum sodium levels were between 135-145 mmol/L. There was a 0.15 mmol/L decrease in blood gas potassium compared to serum levels in cases where serum potassium levels were between 2.5-5.5 mmol/L (95% CI 0.13-0.17). There was a strong positive correlation between blood gas-ionized calcium levels and serum-corrected calcium levels (rho=0.925, P <0.001).

Conclusion: The analysis results of both venous blood gas and serum samples are determined to be compatible, despite slight variations in glucose and electrolyte levels in venous blood gas compared to serum values in DKA patients. In clinically stable DKA cases, blood gas electrolyte results are regarded as sufficient for follow-up, particularly if serum electrolyte levels are in the normal range.