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

@article{citeulike:2615726, abstract = {10.2337/dc07-1683 \^{a}€”Current criteria for the diagnosis of diabetic ketoacidosis (DKA) are limited by their nonspecificity (serum bicarbonate [HCO] 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. \^{a}€”A retrospective review of records from hospitalized diabetic patients was undertaken to determine the concentration of serum \^{I}²-hydroxybutyrate (\^{I}²OHB) that corresponds to a HCO level of 18 mEq/l, the threshold value for diagnosis in recently published consensus criteria. Simultaneous admission \^{I}²OHB and HCO values were recorded from 466 encounters, 129 in children and 337 in adults. \^{a}€”A HCO level of 18 mEq/l corresponded with \^{I}²OHB levels of 3.0 and 3.8 mmol/l in children and adults, respectively. With the use of these threshold \^{I}²OHB values to define DKA, there was substantial discordance (\^{a}ˆ¼\^{a}‰¥20\%) between \^{I}²OHB and conventional diagnostic criteria using HCO, pH, and glucose. In patients with DKA, there was no correlation between HCO and glucose levels on admission and a significant but weak correlation between \^{I}²OHB and glucose levels ( < 0.001). \^{a}€”Where available, serum \^{I}²OHB levels \^{a}‰¥3.0 and \^{a}‰¥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 HCO level for that purpose. The marked variability in the relationship between \^{I}²OHB and HCO is probably due to the presence of other acid-base disturbances, especially hyperchloremic, nonanion gap acidosis.}, author = {Sheikh-Ali, Mae and Karon, Brad S. and Basu, Ananda and Kudva, Yogish C. and Muller, Lisa A. and Xu, Jia and Schwenk, W. Frederick and Miles, John M.}, citeulike-article-id = {2615726}, citeulike-linkout-0 = {http://dx.doi.org/10.2337/dc07-1683}, citeulike-linkout-1 = {http://care.diabetesjournals.org/content/31/4/643.abstract}, citeulike-linkout-2 = {http://care.diabetesjournals.org/content/31/4/643.full.pdf}, citeulike-linkout-3 = {http://care.diabetesjournals.org/cgi/content/abstract/31/4/643}, citeulike-linkout-4 = {http://view.ncbi.nlm.nih.gov/pubmed/18184896}, citeulike-linkout-5 = {http://www.hubmed.org/display.cgi?uids=18184896}, day = {1}, doi = {10.2337/dc07-1683}, journal = {Diabetes Care}, keywords = {diabetes, ketones}, month = {April}, number = {4}, pages = {643--647}, posted-at = {2009-11-07 09:06:43}, priority = {2}, title = {Can Serum \^{I}²-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 N2 - 10.2337/dc07-1683 —Current criteria for the diagnosis of diabetic ketoacidosis (DKA) are limited by their nonspecificity (serum bicarbonate [HCO] 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. —A retrospective review of records from hospitalized diabetic patients was undertaken to determine the concentration of serum β-hydroxybutyrate (βOHB) that corresponds to a HCO level of 18 mEq/l, the threshold value for diagnosis in recently published consensus criteria. Simultaneous admission βOHB and HCO values were recorded from 466 encounters, 129 in children and 337 in adults. —A HCO 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, pH, and glucose. In patients with DKA, there was no correlation between HCO and glucose levels on admission and a significant but weak correlation between βOHB and glucose levels ( < 0.001). —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 HCO level for that purpose. The marked variability in the relationship between βOHB and HCO is probably due to the presence of other acid-base disturbances, especially hyperchloremic, nonanion gap acidosis. IS - 4 JF - Diabetes Care EP - 647 TI - Can Serum β-Hydroxybutyrate Be Used to Diagnose Diabetic Ketoacidosis? VL - 31 SP - 643 KW - diabetes KW - ketones 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 -