{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T10:52:34Z","timestamp":1774954354832,"version":"3.50.1"},"reference-count":16,"publisher":"Cambridge University Press (CUP)","issue":"3","license":[{"start":{"date-parts":[[2020,4,15]],"date-time":"2020-04-15T00:00:00Z","timestamp":1586908800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Prehosp. Disaster med."],"published-print":{"date-parts":[[2020,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S1049023X20000485_as1\" sec-type=\"other\"><jats:title>Background:<\/jats:title><jats:p>Early identification of diabetic ketoacidosis (DKA) may improve clinical outcomes. Prior studies suggest exhaled end tidal carbon dioxide (ETCO2) provides a non-invasive, real-time method to screen for DKA in the emergency department (ED).<\/jats:p><\/jats:sec><jats:sec id=\"S1049023X20000485_as2\" sec-type=\"other\"><jats:title>Methods:<\/jats:title><jats:p>This a retrospective cohort study among patients who activated Emergency Medical Services (EMS) during a one-year period. Initial out-of-hospital vital signs documented by EMS personnel, including ETCO2 and first recorded blood glucose level (BGL), as well as in-hospital records, including laboratory values and diagnosis, were collected. The main outcome was the association between ETCO2 and the diagnosis of DKA.<\/jats:p><\/jats:sec><jats:sec id=\"S1049023X20000485_as3\" sec-type=\"other\"><jats:title>Results:<\/jats:title><jats:p>Of the 118 patients transported with hyperglycemia (defined by BGL &gt;200), six (5%) were diagnosed with DKA. The mean level of ETCO2 in those without DKA was 35mmHg (95% CI, 33-38mmHg) compared to mean levels of 15mmHg (95% CI, 8-21mmHg) in those with DKA (P &lt;.001). The Area Under the Receiver Operating Characteristics (ROC) Curve (AUC) for ETCO2 identifying DKA was 0.96 (95% CI, 0.92-1.00). The correlation coefficient between ETCO2 and serum bicarbonate (HCO3) was 0.436 (P &lt;.001) and the correlation coefficient between ETCO2 and anion gap was -0.397 (P &lt;.001).<\/jats:p><\/jats:sec><jats:sec id=\"S1049023X20000485_as4\" sec-type=\"other\"><jats:title>Conclusion:<\/jats:title><jats:p>Among patients with hyperglycemia, prehospital levels of ETCO2 were significantly lower in patients with DKA compared to those without and were predictive of the diagnosis of DKA. Furthermore, out-of-hospital ETCO2 was significantly correlated with measures of metabolic acidosis.<\/jats:p><\/jats:sec>","DOI":"10.1017\/s1049023x20000485","type":"journal-article","created":{"date-parts":[[2020,4,15]],"date-time":"2020-04-15T07:11:11Z","timestamp":1586934671000},"page":"281-284","source":"Crossref","is-referenced-by-count":11,"title":["Utilizing End-Tidal Carbon Dioxide to Diagnose Diabetic Ketoacidosis in Prehospital Patients with Hyperglycemia"],"prefix":"10.1017","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4586-5916","authenticated-orcid":false,"given":"Christopher","family":"Hunter","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monty","family":"Putman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jermaine","family":"Foster","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amy","family":"Souers","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexa","family":"Rodriguez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Zuver","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linda","family":"Papa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2020,4,15]]},"reference":[{"key":"S1049023X20000485_ref15","doi-asserted-by":"publisher","DOI":"10.1186\/1865-1380-5-31"},{"key":"S1049023X20000485_ref13","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2012.05.034"},{"key":"S1049023X20000485_ref12","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2016.01.017"},{"key":"S1049023X20000485_ref11","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000090008.79790.A7"},{"key":"S1049023X20000485_ref2","first-page":"eI1114","article-title":"Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: review of acute decompensated diabetes in adult patients","volume":"365","author":"Karslioglu French","year":"2019","journal-title":"BNJ."},{"key":"S1049023X20000485_ref10","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-5448.2006.00186.x"},{"key":"S1049023X20000485_ref8","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-1754.2007.01186.x"},{"key":"S1049023X20000485_ref7","doi-asserted-by":"publisher","DOI":"10.1197\/aemj.9.12.1373"},{"key":"S1049023X20000485_ref16","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000007881"},{"key":"S1049023X20000485_ref1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2019.107797"},{"key":"S1049023X20000485_ref9","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2013.10.049"},{"key":"S1049023X20000485_ref4","doi-asserted-by":"publisher","DOI":"10.1034\/j.1399-6576.2003.00091.x"},{"key":"S1049023X20000485_ref3","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0182413"},{"key":"S1049023X20000485_ref6","doi-asserted-by":"publisher","DOI":"10.5811\/westjem.2013.4.14296"},{"key":"S1049023X20000485_ref5","doi-asserted-by":"publisher","DOI":"10.1080\/10903127.2018.1456582"},{"key":"S1049023X20000485_ref14","doi-asserted-by":"publisher","DOI":"10.1080\/10903127.2017.1356409"}],"container-title":["Prehospital and Disaster Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S1049023X20000485","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,5,1]],"date-time":"2020-05-01T10:13:23Z","timestamp":1588328003000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S1049023X20000485\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,4,15]]},"references-count":16,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2020,6]]}},"alternative-id":["S1049023X20000485"],"URL":"https:\/\/doi.org\/10.1017\/s1049023x20000485","relation":{},"ISSN":["1049-023X","1945-1938"],"issn-type":[{"value":"1049-023X","type":"print"},{"value":"1945-1938","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,4,15]]}}}