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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.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

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 -