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

• Published in: Diabetes care Vol. 31; no. 4; pp. 643 - 647
• Main Authors: Sheikh-Ali, Mae, Karon, Brad S, Basu, Ananda, Kudva, Yogish C, Muller, Lisa A, Xu, Jia, Schwenk, W. Frederick, Miles, John M
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01.04.2008
• Subjects: 3-Hydroxybutyric Acid - blood; Adolescent; Adult; Bicarbonates - blood; Biological and medical sciences; Biomarkers - blood; Blood Glucose - analysis; Child; Diabetes Mellitus, Type 1 - blood; Diabetes Mellitus, Type 2 - blood; Diabetes. Impaired glucose tolerance; Diabetic acidosis; Diabetic Ketoacidosis - blood; Diabetic Ketoacidosis - diagnosis; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Humans; Inpatients; Ketoacidosis; Ketone Bodies - blood; Ketone Bodies - urine; Medical research; Medical sciences; Medicine, Experimental; Metabolic diseases; Miscellaneous; Public health. Hygiene; Public health. Hygiene-occupational medicine; Retrospective Studies; Sensitivity and Specificity; Endocrinopathy; Ketone body; Human; Nutrition; Diabetes mellitus; Use; Metabolic diseases; Acid base balance disorder; Metabolic disorder; Ketoacidosis; Serum; Diagnosis; Endocrinology
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/dc07-1683

OBJECTIVE:--Current 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 METHODS--A retrospective review of records from hospitalized diabetic patients was undertaken to determine the concentration of serum β-hydroxybutyrate (βOHB) that corresponds to a HCO₃ level of 18 mEq/l, the threshold value for diagnosis in recently published consensus criteria. Simultaneous admission βOHB and HCO₃ values were recorded from 466 encounters, 129 in children and 337 in adults. RESULTS:--A HCO₃ 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 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 βOHB and glucose levels (P < 0.001). CONCLUSIONS:--Where available, serum βOHB levels >=3.0 and >=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 βOHB and HCO₃ is probably due to the presence of other acid-base disturbances, especially hyperchloremic, nonanion gap acidosis.