Ketone measurements using dipstick methodology in cats with diabetes mellitus

Abstract

The urine and plasma ketone dip tests have a different diagnostic accuracy, and results have to be interpreted differently. Because of its high sensitivity, the plasma ketone dip test performs better than the urine ketone dip test to identify cats with impending or established ketoacidosis.

Accuracy of capillary blood 3-β-hydroxybutyrate determination for the detection and treatment of canine diabetic ketoacidosis

“…Proposed methods to detect the increase of ketone bodies include 3-HB measurement with laboratory methods [7], which is not practical in emergency settings, the determination of urinary or plasma AcAc with dip stick methods [3,31,32], and the detection of 3-HB using a hand-held ketone sensor [6,14,29]. The detection of urinary AcAc is the most commonly used method, but many studies have demonstrated that this test is associated with a considerable risk of false-positive and false-negative results [3,31,32]. Based on the severity of the disease, a false positive result is less dangerous because the disease can then be excluded by the blood gas analysis.…”

“…Conversely, a false negative result may result in underestimation of the patient's ketotic state and consequent misdiagnosis of the DKA. Based on a study conducted by Zeugswetter and Pagiz [32], the determination of plasma ketones by the dipstick test appears to have a greater sensitivity than the urinary ketone test and therefore to be a useful tool to rule out DKA. Both tests only detect the presence of AcAc in urine or plasma samples and not the presence of 3-HB; furthermore, the measurement of plasma ketones by the dipstick test is associated with false positive results [3,32].…”

“…Urinary or plasma semiquantitative measure of AcAc is associated with a considerable risk of false positive and negative results, both in humans and animals [3,6,23,27,32]. Finally, obtaining a urine sample for a rapid diagnosis may be difficult in emergency cases [3,25,27,32]. For this reason, in human medicine, blood ketones are now measured using a hand-held electrochemical sensor that measures 3-HB in 30 sec using capillary whole blood samples [1,25,27,28].…”

“…Hand-held ketone sensors [6,13,14,29] or reference laboratory methods [7,8,31,32] for analysis of venous blood samples were used in these studies, and the results suggested that 3-HB measurement was superior to urinary AcAc for diagnosis of canine and feline DKA [6,13,14,29,31,32]. Therefore, the present study was conducted to evaluate the accuracy of an electrochemical sensor (Optium Xceed; Abbott Laboratories, UK) for measurement of 3-HB from capillary and venous blood samples, and to assess the potential utility of the capillary 3-HB measurement to diagnose and monitor the treatment of canine DKA.…”

Diabetic Ketoacidosis

“…8-6), or plasma from heparinized hematocrit tubes can be used to test for the presence of acetoacetate using urine reagent strips used to document ketonuria (Duarte et al, 2002;Brady et al, 2003;Hoenig et al, 2008;Di Tommaso et al, 2009;Zeugswetter and Pagitz, 2009). Measurement of the blood glucose concentration using a portable blood glucose monitoring device (see Protocol for Generating the Serial Blood Glucose Curve in the Hospital in Chapter 6) and testing for the presence of glycosuria using urine reagent test strips (e.g., Keto-Diastix) allows the rapid confirmation of diabetes mellitus.…”