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Can Serum β-Hydroxybutyrate Be Used to Diagnose Diabetic Ketoacidosis?
Abstract
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.
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“However, in all but one of the subjects in the VLCK diet group capillary beta-hydroxibutirate concentration remained lower than that typically observed in diabetic ketoacidosis in type 1 diabetic subjects.32”
From Short-term safety, tolerability and efficacy of a very low-calorie-ketogenic diet interventional weight loss program versus hypocaloric diet in patients with type 2 diabetes mellitus (2016) · cites this paper as [32]
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Cited by
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Hyperglycemic crises in adult patients with diabetes
Kitabchi, A. E., Umpierrez, G. E., Miles, J. M., & Fisher, J. N. (2009) · Diabetes Care · doi:10.2337/dc09-9032 · Cited by 2,062
Self-citationDiabetic emergencies - ketoacidosis, hyperglycaemic hyperosmolar state and hypoglycaemia
Umpierrez, G., & Korytkowski, M. (2016) · Nature Reviews Endocrinology · doi:10.1038/nrendo.2016.15 · Cited by 563
Dhatariya, K. K., Glaser, N. S., Codner, E., & Umpierrez, G. E. (2020) · Nature Reviews Disease Primers · doi:10.1038/s41572-020-0165-1 · Cited by 461
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Metadata
- Authors
- Sheikh-Ali, M., Karon, B. S., Basu, A., Kudva, Y. C., Muller, L. A., Xu, J., Schwenk, W. F., & Miles, J. M.
- Affiliations
- Division of Endocrinology, Diabetes, Nutrition, and Metabolism, Mayo Clinic, Rochester, Minnesota
- Division of Laboratory Medicine, Mayo Clinic, Rochester, Minnesota
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2008-04-01
- Volume
- 31
- Issue
- 4
- Pages
- 643-647
- ISSN
- 0149-5992
- 1935-5548
- Cited by
- 159
- References
- 2
- Language
- en
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