title: Diagnostic value of end tidal capnography in patients with hyperglycemia in the emergency department.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon. rb94@aub.edu.lb.|Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI, USA. rb94@aub.edu.lb.
authors.forename: Ralphe
authors.initials: R
authors.lastname: Bou Chebl
authors.affiliation: Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Bryan
authors.initials: B
authors.lastname: Madden
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Justin
authors.initials: J
authors.lastname: Belsky
authors.affiliation: Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Elie
authors.initials: E
authors.lastname: Harmouche
authors.affiliation: Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, MI, USA.|Division of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Lenar
authors.initials: L
authors.lastname: Yessayan
mesh_terms: D000328:Adult; D019296:Capnography / Q000379:methods; D003430:Cross-Sectional Studies; D016883:Diabetic Ketoacidosis / Q000175:diagnosis; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D006943:Hyperglycemia; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests
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