Near patient blood ketone measurements and their utility in predicting diabetic ketoacidosis

Harris, Steve; Ng, Richards; Syed, Hannah; Hillson, Rowan

doi:10.1111/j.1464-5491.2004.01374.x

Cited by 37 publications

(21 citation statements)

References 7 publications

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“…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]. This method is actually the recommended method for diagnosis and monitoring of the treatment of DKA, and can be used for the home monitoring of diabetic patients [1,10,12,18,25,26,27,28]. …”

Section: Introductionmentioning

confidence: 99%

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

et al. 2014

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In human medicine, diagnosis of diabetic ketoacidosis (DKA) is usually based on measurement of capillary 3-β-hydroxybutyrate (3-HB) with a hand held ketone sensor. This study was conducted to determine if measurement of capillary 3-HB could be useful for the diagnosis and monitoring of canine DKA. Fifteen dogs with diabetic ketosis and 10 with DKA were evaluated. Paired measurements of 3-HB of capillary and venous blood samples were analysed by the electrochemical sensor and reference method. Use of capillary 3-HB measurement during DKA management was then evaluated through simultaneous measurements of capillary 3-HB, urinary AcAc and venous blood gas analysis. Good agreement between capillary and venous 3-HB measurement was detected by the electrochemical sensor and reference method. Monitoring treatment of DKA revealed a significant correlation between capillary 3-HB and acidosis markers, while no significant correlation was observed between AcAc and acidosis markers. A cut-off value of capillary blood 3-HB >3.8 mmol/L for diagnosis of DKA resulted in 70% and 92% sensitivity and specificity. The electrochemical sensor accurately measures 3-HB concentration in both capillary and venous blood samples, is accurate in diagnosing canine DKA, and appears to reflect the patient's metabolic status during DKA treatment.

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Section: Introductionmentioning

confidence: 99%

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

et al. 2014

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“…Two retrospective emergency-department studies have shown that capillary point-of-care β-OHB is 100% sensitive for DKA (8,9). Charles et al (10) likewise found that β-OHB was 100% sensitive in a prospective study of seven DKA patients.…”

Section: Discussionmentioning

confidence: 99%

“…On the basis of previous literature, we assumed that the true sensitivity of β-OHB for detecting DKA was between 98 and 100% and determined that a sample including 54 cases of DKA would confirm this point estimate with a confidence limit no lower than 90% (8–12). The study was stopped after the 54th DKA patient was enrolled.…”

Section: Methodsmentioning

confidence: 99%

Diagnostic Accuracy of Point-of-Care Testing for Diabetic Ketoacidosis at Emergency-Department Triage

et al. 2011

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OBJECTIVEIn the emergency department, hyperglycemic patients are screened for diabetic ketoacidosis (DKA) via a urine dipstick. In this prospective study, we compared the test characteristics of point-of-care β-hydroxybutyrate (β-OHB) analysis with the urine dipstick.RESEARCH DESIGN AND METHODSEmergency-department patients with blood glucose ≥250 mg/dL had urine dipstick, chemistry panel, venous blood gas, and capillary β-OHB measurements. DKA was diagnosed according to American Diabetes Association criteria.RESULTSOf 516 hyperglycemic subjects, 54 had DKA. The urine dipstick had a sensitivity of 98.1% (95% CI 90.1–100), a specificity of 35.1% (30.7–39.6), a positive predictive value of 15% (11.5–19.2), and a negative predictive value of 99.4% (96.6–100) for DKA. Using the manufacturer-suggested cutoff of >1.5 mmol/L, β-OHB had a sensitivity of 98.1% (90.1–100), a specificity of 78.6% (74.5–82.2), a positive predictive value of 34.9% (27.3–43), and a negative predictive value of 99.7% (98.5–100) for DKA.CONCLUSIONSPoint-of-care β-OHB and the urine dipstick are equally sensitive for detecting DKA (98.1%). However, β-OHB is more specific (78.6 vs. 35.1%), offering the potential to significantly reduce unnecessary DKA work-ups among hyperglycemic patients in the emergency department.

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“…Because concentrations of up to 0.25 mmol/l may commonly be found after an overnight fast, concentrations above 0.3 mmol/l have been regarded as significantly elevated [44][45][46][47]. However, several studies have compared bedside values with laboratory samples [48,35,49], and found a consensus that, using either method, a value of 3.0 mmol/l should be used as the cut-off for diagnosing DKA, or at the very least, the concentration at which urgent medical attention should be sought [35,41,47,50]. Previous work has shown that urine ketone testing and capillary testing had sensitivities of 95-100% in diagnosing DKA (using 3.0 mmol/l as cut-off), but that the capillary testing was significantly faster, and had higher specificity (78-94% vs. <50%) [49][50][51][52][53][54][55].…”

Section: Further Limitations Of Urine and Blood Testingmentioning

confidence: 99%

“…However, several studies have compared bedside values with laboratory samples [48,35,49], and found a consensus that, using either method, a value of 3.0 mmol/l should be used as the cut-off for diagnosing DKA, or at the very least, the concentration at which urgent medical attention should be sought [35,41,47,50]. Previous work has shown that urine ketone testing and capillary testing had sensitivities of 95-100% in diagnosing DKA (using 3.0 mmol/l as cut-off), but that the capillary testing was significantly faster, and had higher specificity (78-94% vs. <50%) [49][50][51][52][53][54][55]. Thus, whilst capillary and urine ketone concentrations are both excellent at ruling out DKA, the use of capillary ketones has the advantage of sparing unnecessary time and expensive laboratory investigation because their use is likely to reduce the number of false positive results.…”

Section: Further Limitations Of Urine and Blood Testingmentioning

confidence: 99%

Blood Ketones: Measurement, Interpretation, Limitations, and Utility in the Management of Diabetic Ketoacidosis

Dhatariya

2016

Rev Diabet Stud

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■ AbstractDiabetic ketoacidosis (DKA) remains a common medical emergency. Over the last few years, new national guidelines have changed the focus in managing the condition from being glucose-centered to ketone-centered. With the advent of advancing technology and the increasing use of hand-held, point-of-care ketone meters, greater emphasis is placed on making treatment decisions based on these readings. Furthermore, recent warnings about euglycemic DKA occurring in people with diabetes using sodium-glucose co-transporter 2 (SGLT-2) inhibitors urge clinicians to inform their patients of this condition and possible testing options. This review describes the reasons for a change in treating DKA, and outlines the benefits and limitations of using ketone readings, in particular highlighting the difference between urine and capillary readings.

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Near patient blood ketone measurements and their utility in predicting diabetic ketoacidosis

Abstract: Measuring beta-OHB when a hyperglycaemic patient is identified could offer a simple method of identifying at an early stage those patients at highest risk of DKA (beta-OHB > 3.0 mmol/l), and redirecting the search for a diagnosis in others (beta-OHB < 1.0 mmol/l).

Cited by 37 publications

References 7 publications

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

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

Diagnostic Accuracy of Point-of-Care Testing for Diabetic Ketoacidosis at Emergency-Department Triage

Blood Ketones: Measurement, Interpretation, Limitations, and Utility in the Management of Diabetic Ketoacidosis

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