Israel Medical Association Journal

Background: Interpretation of blood gases is essential for the correct practice of medicine. Normal ranges for arterial blood gases (ABG) have not been extensively studied in the older population. Also, venous blood gases and venous-arterial pCO₂ gradient have not been studied in this population, even though they signify the majority of hospitalized patients.

Objectives: To determine the normal range for ABG and the bias limits of agreement for arterial-venous difference in the elderly population.

Methods: We recruited 130 elderly patients (> 70 years) and obtained blood gas measurements from venous and arterial blood. Patients were divided into four categories: healthy patients, patients with stable chronic pulmonary disease, hospitalized patients with acute respiratory illness, and hospitalized patients without respiratory disease. Samples were analyzed in a point of care analyzer.

Results: Mean PaCO₂ was 36.9 ± 4.2 mmHg for the healthy control group, 37.0 ± 4.8 mmHg in the stable chronic respiratory group, 37.0 ± 5.0 mmHg in the non-respiratory hospitalization group, and 42.3 ± 11.4 mmHg for the respiratory hospitalization group, Kruskall-Wallis, P <0.0025. Mean bias between venous and arterial CO₂ was +10.0 mmHg with 95% limits of agreement between 2.7 mmHg and -22.8 mmHg.

Conclusions: In elderly patients, the range of PaCO₂ measurements was similar to the accepted normal range in clinical practice. Venous-arterial PCO₂ gradient had high bias and wide limits of agreement, similar to previously published studies.

Background: Diabetic ketoacidosis (DKA) poses a significant medical emergency in both type 1 (T1DM) and type 2 diabetes mellitus (T2DM) patients. Recent attention has focused on the emergence of euglycemic DKA associated with sodium-glucose cotransporter-2 (SGLT2) inhibitors.

Objectives: To understand the epidemiology and outcomes of DKA, particularly in T2DM patients.

Methods: We conducted a retrospective cohort analysis of 204 patients admitted with DKA to Shamir Medical Center (2013–2021). We assessed demographics, clinical characteristics, and outcomes. Patients were stratified by diabetes type and SGLT2 inhibitor treatment status.

Results: Among the 204 patients with DKA, 38.2% had T2DM. Patients with T2DM exhibited older age, higher co-morbidity burden, and greater prevalence of microvascular complications compared to T1DM patients. Mortality rates were notably higher among T2DM patients, despite similar DKA severity at presentation, including in-hospital mortality rates of 6.4% vs. 0%, P < 0.05, and 90-day mortality rates of 7.7% vs. 0%, P < 0.05. T2DM was independently associated with adverse hospitalization outcomes, including a composite of rehospitalization, prolonged hospital stays, and mortality (odds ratio 2.68, 95% confidence interval 1.302–5.557). SGLT2 inhibitor treatment did not affect hospitalization outcomes of patients with T2DM.

Conclusions: Our findings underscore the importance of recognizing DKA as a substantial complication in diabetic patients, particularly those with T2DM. Vigilance in management, adherence to DKA guidelines, and awareness of triggers such as SGLT2 inhibitors are crucial for improving outcomes in this population.