Metabolic trajectories of diabetic ketoacidosis onset described by breath analysis.

This feasibility study aimed to investigate the use of exhaled breath analysis to capture and quantify relative changes of metabolites during resolution of acute diabetic ketoacidosis under insulin and rehydration therapy. Breath analysis was conducted on 30 patients of which 5 with DKA. They inflated Nalophan bags, and their metabolic content was subsequently interrogated by secondary electrospray ionization high-resolution mass spectrometry (SESI-HRMS). SESI-HRMS analysis showed that acetone, pyruvate, and acetoacetate, which are well known to be altered in DKA, were readily detectable in breath of participants with DKA. In addition, a total of 665 mass spectral features were found to significantly correlate with base excess and prompt metabolic trajectories toward an in-control state as they progress toward homeostasis. This study provides proof-of-principle for using exhaled breath analysis in a real ICU setting for DKA monitoring. This non-invasive new technology provides new insights and a more comprehensive overview of the effect of insulin and rehydration during DKA treatment.

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Copyright © 2024 Awchi, Singh, Brenner, Burckhardt, Hess, Zeng, Datta, Frey, Zumsteg, Szinnai and Sinues.

Déclaration de conflit d'intérêts

PS is co-founder of Deep Breath Intelligence AG Switzerland, which develops breath-based diagnostic tools. KDS and JZ are consultants for Deep Breath Intelligence AG Switzerland. The University Children’s Hospital Basel is a shareholder of Deep Breath Intelligence AG Switzerland. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be constructed as a potential conflict of interest.