Can serum β-hydroxybutyrate be used to diagnose diabetic ketoacidosis?

Mae Sheikh-Ali, Brad S. Karon, Ananda Basu, Yogish C Kudva, Lisa A. Muller, Jia Xu, W. Frederick Schwenk, John M. Miles

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Abstract

OBJECTIVE-Current criteria for the diagnosis of diabetic ketoacidosis (DKA) are limited by their nonspecificity (serum bicarbonate [HCO 3] 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 METHODS-A etrospective review of records from hospitalized diabetic patients was undertaken to determine the concentration of serum β-hydroxy-butyrate βOHB) that corresponds to a HCO 3 level of 18 mEq/l, the threshold value for diagnosis in recently published consensus criteria. Simultaneous admission βOHB and HCO 3 values were recorded from 466 encounters, 129 in children and 337 in adults. RESULTS-A HCO 3 level of 18 mEq/l corresponded with βOHB levels of 3.0 and 3.8 mmol/l in children and adults, respectively. With the use of these threshold βOHB values to define DKA, there was substantial discordance (̃≥20%) between βOHB and conventional diagnostic criteria using HCO 3, pH, and glucose. In patients with DKA, there was no correlation between HCO 3 and glucose levels on admission and a significant but weak correlation between βOHB and glucose levels (P < 0.001). CONCLUSIONS -Where available, serum βOHB levels ≥3.0 and ≥ 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 HCO 3 level for that purpose. The marked variability in the relationship between ( OHB and HCO 3 is probably due to the presence of other acid-base disturbances, especially hyperchloremic, nonanion gap acidosis.

Original languageEnglish (US)
Pages (from-to)643-647
Number of pages5
JournalDiabetes Care
Volume31
Issue number4
DOIs
StatePublished - Apr 2008

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Hydroxybutyrates
Diabetic Ketoacidosis
Serum
Ketosis
Glucose
Ketone Bodies
Butyrates
Bicarbonates
Acidosis
Anions
Research Design
Acids

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

Cite this

Sheikh-Ali, M., Karon, B. S., Basu, A., Kudva, Y. C., Muller, L. A., Xu, J., ... Miles, J. M. (2008). Can serum β-hydroxybutyrate be used to diagnose diabetic ketoacidosis? Diabetes Care, 31(4), 643-647. https://doi.org/10.2337/dc07-1683

Can serum β-hydroxybutyrate be used to diagnose diabetic ketoacidosis? / Sheikh-Ali, Mae; Karon, Brad S.; Basu, Ananda; Kudva, Yogish C; Muller, Lisa A.; Xu, Jia; Schwenk, W. Frederick; Miles, John M.

In: Diabetes Care, Vol. 31, No. 4, 04.2008, p. 643-647.

Research output: Contribution to journalArticle

Sheikh-Ali, M, Karon, BS, Basu, A, Kudva, YC, Muller, LA, Xu, J, Schwenk, WF & Miles, JM 2008, 'Can serum β-hydroxybutyrate be used to diagnose diabetic ketoacidosis?', Diabetes Care, vol. 31, no. 4, pp. 643-647. https://doi.org/10.2337/dc07-1683
Sheikh-Ali, Mae ; Karon, Brad S. ; Basu, Ananda ; Kudva, Yogish C ; Muller, Lisa A. ; Xu, Jia ; Schwenk, W. Frederick ; Miles, John M. / Can serum β-hydroxybutyrate be used to diagnose diabetic ketoacidosis?. In: Diabetes Care. 2008 ; Vol. 31, No. 4. pp. 643-647.
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AU - Sheikh-Ali, Mae

AU - Karon, Brad S.

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AU - Muller, Lisa A.

AU - Xu, Jia

AU - Schwenk, W. Frederick

AU - Miles, John M.

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N2 - OBJECTIVE-Current criteria for the diagnosis of diabetic ketoacidosis (DKA) are limited by their nonspecificity (serum bicarbonate [HCO 3] 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 METHODS-A etrospective review of records from hospitalized diabetic patients was undertaken to determine the concentration of serum β-hydroxy-butyrate βOHB) that corresponds to a HCO 3 level of 18 mEq/l, the threshold value for diagnosis in recently published consensus criteria. Simultaneous admission βOHB and HCO 3 values were recorded from 466 encounters, 129 in children and 337 in adults. RESULTS-A HCO 3 level of 18 mEq/l corresponded with βOHB levels of 3.0 and 3.8 mmol/l in children and adults, respectively. With the use of these threshold βOHB values to define DKA, there was substantial discordance (̃≥20%) between βOHB and conventional diagnostic criteria using HCO 3, pH, and glucose. In patients with DKA, there was no correlation between HCO 3 and glucose levels on admission and a significant but weak correlation between βOHB and glucose levels (P < 0.001). CONCLUSIONS -Where available, serum βOHB levels ≥3.0 and ≥ 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 HCO 3 level for that purpose. The marked variability in the relationship between ( OHB and HCO 3 is probably due to the presence of other acid-base disturbances, especially hyperchloremic, nonanion gap acidosis.

AB - OBJECTIVE-Current criteria for the diagnosis of diabetic ketoacidosis (DKA) are limited by their nonspecificity (serum bicarbonate [HCO 3] 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 METHODS-A etrospective review of records from hospitalized diabetic patients was undertaken to determine the concentration of serum β-hydroxy-butyrate βOHB) that corresponds to a HCO 3 level of 18 mEq/l, the threshold value for diagnosis in recently published consensus criteria. Simultaneous admission βOHB and HCO 3 values were recorded from 466 encounters, 129 in children and 337 in adults. RESULTS-A HCO 3 level of 18 mEq/l corresponded with βOHB levels of 3.0 and 3.8 mmol/l in children and adults, respectively. With the use of these threshold βOHB values to define DKA, there was substantial discordance (̃≥20%) between βOHB and conventional diagnostic criteria using HCO 3, pH, and glucose. In patients with DKA, there was no correlation between HCO 3 and glucose levels on admission and a significant but weak correlation between βOHB and glucose levels (P < 0.001). CONCLUSIONS -Where available, serum βOHB levels ≥3.0 and ≥ 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 HCO 3 level for that purpose. The marked variability in the relationship between ( OHB and HCO 3 is probably due to the presence of other acid-base disturbances, especially hyperchloremic, nonanion gap acidosis.

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