Near patient blood ketone measurements and their utility in predicting diabetic ketoacidosis

Authors: Harris, S.; Ng, R.; Syed, H.; Hillson, R.

Source: Diabetic Medicine, Volume 22, Number 2, February 2005 , pp. 221-224(4)

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Abstract:

Aim

To assess the utility of near patient blood ketone measurements in predicting diabetic ketoacidosis (DKA) among a group of hyperglycaemic unwell patients presenting to a hospital emergency department. Methods

Near patient blood β-hydroxybutyrate (β-OHB) testing has recently been introduced as a new tool in our hospital Accident and Emergency department (A&E) for patients with a finger-prick glucose of > 11 mmol/l. We reviewed the records of the first 50 patients to have a β-OHB measurement to establish if they developed DKA or received treatment with intravenous insulin within 48 h of presentation. We then compared the diagnostic power of β-OHB measurements with other clinical, physiological and biochemical markers of DKA. Results

Nine patients had DKA, eight had a compensated metabolic acidosis secondary to raised serum ketones, and 33 had no evidence of DKA during the following 48 h. The median (range) β-OHB levels in each group were 6.0 (3.1–6.0) mmol/l, 3.4 (1.2–5.7) mmol/l, and 0.1 (0.0–1.2) mmol/l, respectively. A β-OHB level of ≥ 3.0 mmol/l had a sensitivity of 100% and specificity of 88% for DKA. All those with β-OHB level > 3.0 mmol/l required treatment with intravenous insulin. Conclusion

Measuring β-OHB when a hyperglycaemic patient is identified could offer a simple method of identifying at an early stage those patients at highest risk of DKA (β-OHB > 3.0 mmol/l), and redirecting the search for a diagnosis in others (β-OHB < 1.0 mmol/l).

Diabet. Med. (2004)

Keywords: β-hydroxybutyrate; DKA; emergency department; intravenous insulin

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1464-5491.2004.01374.x

Affiliations: 1: Diabeticare, The Hillingdon Hospital, Uxbridge, UK

Publication date: 2005-02-01