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

Oleh:

Sheikh-Ali, Mae ; Karon, Brad S. ; Basu, Ananda ; Kudva,Yogish C. ; Muller, Lisa A. ; and Others

Jenis: Article from Journal - ilmiah internasional
Dalam koleksi: Diabetes Care vol. 31 no. 04 (Apr. 2008), page 643.
Topik: AcAc; acetoacetate ; ßOHB; ß-hydroxybutyrate ; DKA; diabetic ketoacidosis ; HCO3; bicarbonate ; HHS; hyperglycemic hyperosmolar syndrome ; POC; point-of-care ; ROC; receiver operating characteristic

Ketersediaan

Perpustakaan FK Nomor Panggil: D05.K.2008.02 Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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Isi artikel

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 ß-hydroxybutyrate (ßOHB) that corresponds to a HCO3 level of 18 mEq/l, the threshold value for diagnosis in recently published consensus criteria. Simultaneous admission ßOHB 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 ßOHB levels of 3.0 and 3.8 mmol/l in children and adults, respectively. With the use of these threshold ßOHB values to define DKA, there was substantial discordance (20%) between ßOHB 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 ßOHB and glucose levels (P < 0.001). CONCLUSIONS—Where available, serum ßOHB 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 ßOHB and HCO3 is probably due to the presence of other acid-base disturbances, especially hyperchloremic, nonanion gap acidosis.

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