Key result
In children presenting with diabetic ketoacidosis, pH and bicarbonate levels were strongly correlated (r=0.64), whereas pH and PCO2 were only weakly correlated (r=0.17).
Cross-Sectional (n=1,681)
Yes
Effect estimate: r=0.64 for pH and bicarbonate; r=0.17 for pH and PCO2
p-value: p=<0.001
In pediatric DKA, elevated glucose levels largely reflect alterations in glomerular filtration rate, and weak correlations between pH and PCO2 suggest highly variable individual respiratory responses to acidosis.
Supports prioritizing bicarbonate for acidosis evaluation in pediatric DKA; leaves open the clinical impact of variable respiratory compensation.
Objectives Investigating empirical relationships among laboratory measures in children with diabetic ketoacidosis (DKA) can provide insights into physiological alterations occurring during DKA. We determined whether alterations in laboratory measures during DKA conform to theoretical predictions. Methods We used Pearson correlation statistics and linear regression to investigate correlations between blood glucose, electrolytes, pH and PCO2 at emergency department presentation in 1,681 pediatric DKA episodes. Among children with repeat DKA episodes, we also assessed correlations between laboratory measures at the first vs. second episode. Results pH and bicarbonate levels were strongly correlated (r=0.64), however, pH and PCO2 were only loosely correlated (r=0.17). Glucose levels were correlated with indicators of dehydration and kidney function (blood urea nitrogen (BUN), r=0.44; creatinine, r=0.42; glucose-corrected sodium, r=0.32). Among children with repeat DKA episodes, PCO2 levels tended to be similar at the first vs. second episode (r=0.34), although pH levels were only loosely correlated (r=0.19). Conclusions Elevated glucose levels at DKA presentation largely reflect alterations in glomerular filtration rate. pH and PCO2 are weakly correlated suggesting that respiratory responses to acidosis vary among individuals and may be influenced by pulmonary and central nervous system effects of DKA.
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Glaser et al. (2023) conducted a cross-sectional in Diabetic ketoacidosis (DKA) (n=1,681). Biochemical measures at DKA presentation was evaluated on Correlations between blood glucose, electrolytes, pH and PCO2 at emergency department presentation (r=0.64 for pH and bicarbonate; r=0.17 for pH and PCO2, p=<0.001). In children presenting with diabetic ketoacidosis, pH and bicarbonate levels were strongly correlated (r=0.64), whereas pH and PCO2 were only weakly correlated (r=0.17).
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