Can Serum beta-Hydroxybutyrate Be Used to Diagnose Diabetic Ketoacidosis?

@article{citeulike:2615726, abstract = {OBJECTIVECurrent criteria for the diagnosis of diabetic ketoacidosis (DKA) are limited by their nonspecificity (serum bicarbonate [HCO3] and pH) and qualitative nature (the presence of ketonemia/ketonuria). The present study was undertaken to determine whether quantitative measurement of a ketone body anion could be used to diagnose DKA. RESEARCH DESIGN AND METHODSA retrospective review of records from hospitalized diabetic patients was undertaken to determine the concentration of serum -hydroxybutyrate (OHB) that corresponds to a HCO3 level of 18 mEq/l, the threshold value for diagnosis in recently published consensus criteria. Simultaneous admission OHB and HCO3 values were recorded from 466 encounters, 129 in children and 337 in adults. RESULTSA HCO3 level of 18 mEq/l corresponded with OHB levels of 3.0 and 3.8 mmol/l in children and adults, respectively. With the use of these threshold OHB values to define DKA, there was substantial discordance ([~][\&ge;]20\%) between OHB and conventional diagnostic criteria using HCO3, pH, and glucose. In patients with DKA, there was no correlation between HCO3 and glucose levels on admission and a significant but weak correlation between OHB and glucose levels (P < 0.001). CONCLUSIONSWhere available, serum OHB levels [\&ge;]3.0 and [\&ge;]3.8 mmol/l in children and adults, respectively, in the presence of uncontrolled diabetes can be used to diagnose DKA and may be superior to the serum HCO3 level for that purpose. The marked variability in the relationship between OHB and HCO3 is probably due to the presence of other acid-base disturbances, especially hyperchloremic, nonanion gap acidosis. 10.2337/dc07-1683}, author = {Sheikh-Ali, Mae and Karon, Brad S. and Basu, Ananda and Kudva, Yogish C. and Muller, Lisa A. and Xu, Jia and Schwenk, Frederick W. and Miles, John M. }, citeulike-article-id = {2615726}, doi = {10.2337/dc07-1683}, journal = {Diabetes Care}, month = {April}, number = {4}, pages = {643--647}, posted-at = {2008-03-31 11:24:11}, priority = {2}, title = {Can Serum {beta}-Hydroxybutyrate Be Used to Diagnose Diabetic Ketoacidosis?}, url = {http://dx.doi.org/10.2337/dc07-1683}, volume = {31}, year = {2008} }

TY - JOUR ID - citeulike:2615726 L3 - citeulike-article-id:2615726 TI - Can Serum {beta}-Hydroxybutyrate Be Used to Diagnose Diabetic Ketoacidosis? JF - Diabetes Care VL - 31 IS - 4 SP - 643 EP - 647 N2 - OBJECTIVECurrent criteria for the diagnosis of diabetic ketoacidosis (DKA) are limited by their nonspecificity (serum bicarbonate [HCO3] and pH) and qualitative nature (the presence of ketonemia/ketonuria). The present study was undertaken to determine whether quantitative measurement of a ketone body anion could be used to diagnose DKA. RESEARCH DESIGN AND METHODSA retrospective review of records from hospitalized diabetic patients was undertaken to determine the concentration of serum -hydroxybutyrate (OHB) that corresponds to a HCO3 level of 18 mEq/l, the threshold value for diagnosis in recently published consensus criteria. Simultaneous admission OHB and HCO3 values were recorded from 466 encounters, 129 in children and 337 in adults. RESULTSA HCO3 level of 18 mEq/l corresponded with OHB levels of 3.0 and 3.8 mmol/l in children and adults, respectively. With the use of these threshold OHB values to define DKA, there was substantial discordance ([~][&ge;]20%) between OHB and conventional diagnostic criteria using HCO3, pH, and glucose. In patients with DKA, there was no correlation between HCO3 and glucose levels on admission and a significant but weak correlation between OHB and glucose levels (P < 0.001). CONCLUSIONSWhere available, serum OHB levels [&ge;]3.0 and [&ge;]3.8 mmol/l in children and adults, respectively, in the presence of uncontrolled diabetes can be used to diagnose DKA and may be superior to the serum HCO3 level for that purpose. The marked variability in the relationship between OHB and HCO3 is probably due to the presence of other acid-base disturbances, especially hyperchloremic, nonanion gap acidosis. 10.2337/dc07-1683 AU - Sheikh-Ali, Mae AU - Karon, Brad AU - Basu, Ananda AU - Kudva, Yogish AU - Muller, Lisa AU - Xu, Jia AU - Schwenk, Frederick AU - Miles, John PY - 2008/04/01/ UR - http://dx.doi.org/10.2337/dc07-1683 ER -