389 - Comparison of Point of Care Versus Serum Electrolytes in Pediatric Diabetic Ketoacidosis

Poster Number: 389
Publication Number: 389.406

Kevin Gutermuth, University of Alabama at Birmingham, Birmingham, AL, United States; Charli Cohen, University of Alabama- Birmingham, Birmingham, AL, United States; Alexis Kinzer, University of Alabama School of Medicine, Birmingham, AL, United States; William King, University of Alabama School of Medicine, Orange Beach, AL, United States

Background:
Diabetic ketoacidosis (DKA) is a common presentation of patients in the Emergency Department (ED). DKA (hyperglycemia, metabolic acidosis, and ketosis) needs prompt recognition and treatment. A challenge in the ED is time from presentation to initial lab results. Often, bedside electrolyte devices are used to expedite care.


Objective:
The purpose of this study was to compare sodium (Na), potassium (K), glucose, and bicarbonate (HCO3) values reported by the bedside (epoc®) system versus the hospital lab (Abbott Architect ci8200). 


Design/Methods: Our study included patients with suspected or documented DKA. Demographic data [age, gender, race, weight, diagnosis, pH, Na, K, HCO3, glucose, date and time of lab sample, and delta values (difference between POC sample and hospital lab sample) for each] was collected, entered in Excel, and Epi Info Version 7 (CDC) and used for correlation analyses. Lab sample notes about specimen issues (lipemia, hemolysis, delays in lab acquisition) were noted. Histograms of delta values were made to show outliers (samples exceeding delta standards developed by the primary investigator and our hospital lab): Na >4 mmol/l, K >0.5 mmol/l, glucose >10%.

Results:
A total of 376 charts were reviewed. 125 charts were excluded for the following: duplicate records, undetectable electrolyte values, or non-venous blood gas analysis. Mean age was 12.6 years, range 1–21 yrs. Demographics included 129 (51.3%) male and 122 (48.7%) female; 135 (53.8%) White, 107 (42.6%) African American, and 9 (3.6%) Hispanic. 85 patients (33.9%) were new-onset diagnoses of DM in DKA, while remaining patients were previously diagnosed diabetics. The mean time delay between orders placed and initial IV access with VBG sample results was 7.6 minutes. The mean time between POC results and hospital lab results was 59.2 minutes. Histogram analysis of delta values identified outliers for Na (94), K (30), glucose (47), TCO2 (64) and HCO3 (85). Most delta values were within established standards: Na (62.6%), K (88.5%), glucose (81.3%), TCO2 (74.6%), and HCO3 (66.3%). POC Na values were skewed towards a lower value, while TCO2 and HCO3 values were skewed towards a higher value. 


Conclusion(s):
POC electrolyte analyzers expedite diagnosis and care in DKA. Our study reports POC K and glucose values correlate >81% accuracy to the hospital lab value. The Na values had 63% accuracy and the calculated HCO3 value ranged from 66-74% accuracy. Refinement of techniques and calibration of bedside systems are needed to improve reliability and accuracy, leading to faster treatment and overall improvement of patient care.