DKA and PH

Q: During the management of Diabetes Ketoacidosis (DKA), monitoring of which PH is recommended?

A) Arterial
B) Venous


Answer: B 

 In general, the difference between arterial and venous PH is only 0.03 units. If not required there is no need to insert arterial line just for the purpose of DKA management. Venous PH, in general, is adequate to monitor the improvement in DKA. It should be complemented by serum bicarbonate and the serum anion gap from the chemistry. In some institutes bedside ketone meters to measure capillary blood beta-hydroxybutyrate are available which is a good alternative.

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References:

1. Middleton P, Kelly AM, Brown J, Robertson M. Agreement between arterial and central venous values for pH, bicarbonate, base excess, and lactate. Emerg Med J 2006; 23:622. 

2. Loh TP, Saw S, Sethi SK. Bedside monitoring of blood ketone for management of diabetic ketoacidosis: proceed with care. Diabet Med 2012; 29:827.