Venous blood gas in adult patients with diabetic ketoacidosis
Date First Published:
May 22, 2002
Last Updated:
July 1, 2003
Report by:
Ziauddin Hassan, Devasena M Subramonyam, Registrars (Ninewells Hospital, Dundee)
Search checked by:
Shobhan Thakore, Ninewells Hospital, Dundee
Three-Part Question:
In [an adult patient with diabetic ketoacidosis] do [venous blood gases] accurately demonstrate [the degree of acidosis]?
Clinical Scenario:
A 22 year old insulin dependant 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.
Search Strategy:
Medline 1966-04/03 using the OVID interface.
Search Details:
[(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.
Outcome:
Altogether 27 papers were found of which only 2 are relevant and of sufficient quality for inclusion.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Comparison of Arterial and venous blood gases in the initial emergency department evaluation of patients with diabetic ketoacidosis. Brandenburg MA, Dire DJ. 1998, USA | 38 patients with DKA presented to emergency department Venous vs arterial pH |
Prospective | Mean difference in pH | -0.03 | Small numbers No control group |
| Comparison of blood gases and acid-base measurements in arterial and venous blood samples in patients with uremic acidosis and diabetic ketoacidosis in the emergency room. Gokel Y, Paydas S, Koseoglu Z, et al. 2000, Turkey | 152 samples from 100 - uremic patients 21 patients with DKA and 31 healthy volunteers Venous vs arterial pH |
Prospective | Mean difference in pH | -0.05 | Small numbers Unequal number of patients in each group |
Author Commentary:
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.
Bottom Line:
There is no clinically significant difference between arterial and venous pH estimates in patients with diabetic ketoacidosis.
References:
- Brandenburg MA, Dire DJ.. Comparison of Arterial and venous blood gases in the initial emergency department evaluation of patients with diabetic ketoacidosis.
- Gokel Y, Paydas S, Koseoglu Z, et al.. Comparison of blood gases and acid-base measurements in arterial and venous blood samples in patients with uremic acidosis and diabetic ketoacidosis in the emergency room.