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  • Title: [Capillary beta-hydroxybutyrate determination for monitoring diabetic ketoacidosis].
    Author: Rodríguez-Merchán B, Casteràs A, Domingo E, Nóvoa FJ, López Y, Cabezas-Agricola JM, Rivero T, Parramón M, Mesa J.
    Journal: Endocrinol Nutr; 2011; 58(7):347-52. PubMed ID: 21737365.
    Abstract:
    BACKGROUND AND OBJECTIVE: Diabetic ketoacidosis (DKA) is the most severe acute metabolic complication of type 1 diabetes mellitus. Insulin treatment is commonly guided by plasma glucose levels and changes in venous blood gases, while β-hydroxibutyrate (BHB) levels are rarely measured. The study objective was to evaluate the value of capillary BHB monitoring in the course and resolution of DKA. PATIENTS AND METHODS: Thirty patients with type 1 diabetes admitted for DKA were enrolled. A standard protocol including monitoring of blood glucose, venous blood gases, semiquantitative ketonuria, and capillary BHB was used. Patients were divided into three groups by time to DKA resolution (group 1:<24 h, group 2: 24-48 h, group 3: >48 h), and BHB results were compared to all other biochemical measurements. RESULTS: Mean laboratory results upon admission were: blood glucose 415 (standard deviation [SD] 106) mg/dL; bicarbonate 9.6 (SD 1.5) mmol/L; pH 7.13 (SD 0.04); BHB 4.33 (SD 0.48) mmol/L, and ketonuria 3+ in 22 patients and 4+ in 6. BHB correlated well with bicarbonate (r=-0.24139; P=0.0161) and pH (r=-0.56419; P<0.0001). BHB normalized earlier than ketonuria in all cases (group 1: 15.5 vs 18.8 hours P<0.05; group 2: 18.2 vs 23.5 hours P<0.01; group 3: 37.3 vs 41.7 hours P<0.01). Ten percent of patients still had ketonuria when blood ketone levels were already normal (<0.5 mmol/L). CONCLUSION: BHB measurement is an easy, practical, and reliable monitoring method in DKA and may be used as a parameter to adjust insulin treatment.
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