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The direct measurement of 3-beta-hydroxy butyrate enhances the management of diabetic ketoacidosis in children and reduces time and costs of treatment.
Diabetes Nutr Metab 2003 Oct-Dec; 16(5-6):312-6DN

Abstract

In this study the effectiveness of a quantitative test of beta-hydroxybutyrate (beta-HBA) against a commercial test for urine ketone bodies (UKB) in monitoring diabetic ketoacidosis (DKA) was evaluated to verify whether this ketone-testing method was able to reduce the monitoring costs and professional burden of nurses and physicians. Thirty-three children with severe (arterial pH < or = 7.2) or moderate (7.2 < pH < or = 7.3) DKA were studied. Sixteen patients were randomly monitored with blood beta-HBA (group 1) and 17 by UKB (group 2). Contrary to UKB, beta-HBA levels appeared correlated with: HbA1c values on admission (r = 0.99; p = 0.0001); latent period before diagnosis of diabetes (r = 0.95; p = 0.0001); changes in arterial pH (r = -0.82; p = 0.0001) and blood bicarbonate values (r = -0.63; p = 0.001) during the treatment for DKA. Required time to achieve the resolution of ketosis in group 1 patients was related to the values of beta-HBA on admission (r = 0.84; p < 0.001). Determination of beta-HBA showed that ketosis in group 1 patients cleared 4 to 9.5 hours earlier than in group 2. Due to this early normalization, the patients of group 1 left the Intensive Care Unit 6.5 +/- 1.5 hr earlier than those of group 2. This led to 22 hr saved for clinical assessment and 375 laboratory investigations for a total saving of 2940 euros including costs for laboratory tests (29.8%) and clinical assessment (70.2%). Quantitative determination of beta-HBA levels seems to offer useful information for monitoring DKA in newly-diagnosed diabetic children and for reducing time and costs in an Intensive Care Unit.

Authors+Show Affiliations

Department of Pediatrics, Chair of Pediatrics, Regional Diabetes Centre for Children and Adolescents, University of Parma, V.le A. Gramsci 14, I-43100 Parma, Italy. vanelli@unipr.it

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

15000443

Citation

Vanelli, M, et al. "The Direct Measurement of 3-beta-hydroxy Butyrate Enhances the Management of Diabetic Ketoacidosis in Children and Reduces Time and Costs of Treatment." Diabetes, Nutrition & Metabolism, vol. 16, no. 5-6, 2003, pp. 312-6.
Vanelli M, Chiari G, Capuano C, et al. The direct measurement of 3-beta-hydroxy butyrate enhances the management of diabetic ketoacidosis in children and reduces time and costs of treatment. Diabetes Nutr Metab. 2003;16(5-6):312-6.
Vanelli, M., Chiari, G., Capuano, C., Iovane, B., Bernardini, A., & Giacalone, T. (2003). The direct measurement of 3-beta-hydroxy butyrate enhances the management of diabetic ketoacidosis in children and reduces time and costs of treatment. Diabetes, Nutrition & Metabolism, 16(5-6), pp. 312-6.
Vanelli M, et al. The Direct Measurement of 3-beta-hydroxy Butyrate Enhances the Management of Diabetic Ketoacidosis in Children and Reduces Time and Costs of Treatment. Diabetes Nutr Metab. 2003;16(5-6):312-6. PubMed PMID: 15000443.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The direct measurement of 3-beta-hydroxy butyrate enhances the management of diabetic ketoacidosis in children and reduces time and costs of treatment. AU - Vanelli,M, AU - Chiari,G, AU - Capuano,C, AU - Iovane,B, AU - Bernardini,A, AU - Giacalone,T, PY - 2004/3/6/pubmed PY - 2004/6/21/medline PY - 2004/3/6/entrez SP - 312 EP - 6 JF - Diabetes, nutrition & metabolism JO - Diabetes Nutr. Metab. VL - 16 IS - 5-6 N2 - In this study the effectiveness of a quantitative test of beta-hydroxybutyrate (beta-HBA) against a commercial test for urine ketone bodies (UKB) in monitoring diabetic ketoacidosis (DKA) was evaluated to verify whether this ketone-testing method was able to reduce the monitoring costs and professional burden of nurses and physicians. Thirty-three children with severe (arterial pH < or = 7.2) or moderate (7.2 < pH < or = 7.3) DKA were studied. Sixteen patients were randomly monitored with blood beta-HBA (group 1) and 17 by UKB (group 2). Contrary to UKB, beta-HBA levels appeared correlated with: HbA1c values on admission (r = 0.99; p = 0.0001); latent period before diagnosis of diabetes (r = 0.95; p = 0.0001); changes in arterial pH (r = -0.82; p = 0.0001) and blood bicarbonate values (r = -0.63; p = 0.001) during the treatment for DKA. Required time to achieve the resolution of ketosis in group 1 patients was related to the values of beta-HBA on admission (r = 0.84; p < 0.001). Determination of beta-HBA showed that ketosis in group 1 patients cleared 4 to 9.5 hours earlier than in group 2. Due to this early normalization, the patients of group 1 left the Intensive Care Unit 6.5 +/- 1.5 hr earlier than those of group 2. This led to 22 hr saved for clinical assessment and 375 laboratory investigations for a total saving of 2940 euros including costs for laboratory tests (29.8%) and clinical assessment (70.2%). Quantitative determination of beta-HBA levels seems to offer useful information for monitoring DKA in newly-diagnosed diabetic children and for reducing time and costs in an Intensive Care Unit. SN - 0394-3402 UR - https://www.unboundmedicine.com/medline/citation/15000443/The_direct_measurement_of_3_beta_hydroxy_butyrate_enhances_the_management_of_diabetic_ketoacidosis_in_children_and_reduces_time_and_costs_of_treatment_ L2 - https://medlineplus.gov/a1c.html DB - PRIME DP - Unbound Medicine ER -