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Urinary acetoacetate or capillary beta-hydroxybutyrate for the diagnosis of ketoacidosis in the Emergency Department setting.
Eur J Emerg Med 2004; 11(5):251-8EJ

Abstract

OBJECTIVES

We compared the semiquantitative measurement of acetoacetate using urinary dipsticks with the bedside quantitative fingerprick measurement of the principal ketone bodies 3-beta-hydroxybutyrate, for the diagnosis of ketoacidosis.

METHODS

This is a one year retrospective study of patients who presented with hyperglycemia levels of 250 mg/l or greater in the Emergency Department setting. We compared the sensitivity, specificity, and predictive value of ketonuria and ketonemia for the diagnosis of ketoacidosis (urine or blood ketone bodies, blood bicarbonates <20 mmol/l, anion gap >16 meq/l) in a sample of patients for whom the levels of ketone bodies in the blood and urine as well as serum electrolytes were available.

RESULTS

We studied 355 hyperglycemic patients. The median time between arrival and dipstick testing was 21 min, and was greater than 2 h in more than 10% of cases. Comparison between ketonuria and ketonemia was performed in 173 patients (6% with diabetic ketoacidosis). Ketonuria equal to or less than one cross or a 3-beta-hydroxybutyrate value lower than 3 mmol/l enabled ketoacidosis to be excluded (negative predictive value 100%). At two-cross cutoff points for ketonuria and at the 3 mmol/l cutoff point for ketonemia, the two tests had the same sensitivity (100%), but the specificity of 3-beta-hydroxybutyrate (94%) was significantly higher (P<0.0001) than that of ketonuria (77%). The best positive predictive value for ketonemia was obtained at the 5 mmol/l cutoff point (100%) and for ketonuria at the three-cross cutoff point (26%). At the three-cross cutoff point for ketonuria and at the 5 mmol/l cutoff point for ketonemia, the two tests had the same negative likelihood ratio (0.1), but the positive likelihood ratio of 3-beta-hydroxybutyrate (infinite) was higher than that of ketonuria.

CONCLUSION

The measurement of 3-beta-hydroxybutyrate in capillary blood is faster and more effective than the use of dipsticks in the urine to detect ketoacidosis in the Emergency Department setting.

Authors+Show Affiliations

Department of Emergency Medicine, Hopital Saint-Louis, University of Paris VII, Paris, France. pierre.taboulet@sls.ap-hop-paris.frNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

15359197

Citation

Taboulet, Pierre, et al. "Urinary Acetoacetate or Capillary Beta-hydroxybutyrate for the Diagnosis of Ketoacidosis in the Emergency Department Setting." European Journal of Emergency Medicine : Official Journal of the European Society for Emergency Medicine, vol. 11, no. 5, 2004, pp. 251-8.
Taboulet P, Haas L, Porcher R, et al. Urinary acetoacetate or capillary beta-hydroxybutyrate for the diagnosis of ketoacidosis in the Emergency Department setting. Eur J Emerg Med. 2004;11(5):251-8.
Taboulet, P., Haas, L., Porcher, R., Manamani, J., Fontaine, J. P., Feugeas, J. P., & Gautier, J. F. (2004). Urinary acetoacetate or capillary beta-hydroxybutyrate for the diagnosis of ketoacidosis in the Emergency Department setting. European Journal of Emergency Medicine : Official Journal of the European Society for Emergency Medicine, 11(5), pp. 251-8.
Taboulet P, et al. Urinary Acetoacetate or Capillary Beta-hydroxybutyrate for the Diagnosis of Ketoacidosis in the Emergency Department Setting. Eur J Emerg Med. 2004;11(5):251-8. PubMed PMID: 15359197.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Urinary acetoacetate or capillary beta-hydroxybutyrate for the diagnosis of ketoacidosis in the Emergency Department setting. AU - Taboulet,Pierre, AU - Haas,Laurent, AU - Porcher,Raphael, AU - Manamani,Jaffar, AU - Fontaine,Jean-Paul, AU - Feugeas,Jean-Paul, AU - Gautier,Jean-Francois, PY - 2004/9/11/pubmed PY - 2005/2/12/medline PY - 2004/9/11/entrez SP - 251 EP - 8 JF - European journal of emergency medicine : official journal of the European Society for Emergency Medicine JO - Eur J Emerg Med VL - 11 IS - 5 N2 - OBJECTIVES: We compared the semiquantitative measurement of acetoacetate using urinary dipsticks with the bedside quantitative fingerprick measurement of the principal ketone bodies 3-beta-hydroxybutyrate, for the diagnosis of ketoacidosis. METHODS: This is a one year retrospective study of patients who presented with hyperglycemia levels of 250 mg/l or greater in the Emergency Department setting. We compared the sensitivity, specificity, and predictive value of ketonuria and ketonemia for the diagnosis of ketoacidosis (urine or blood ketone bodies, blood bicarbonates <20 mmol/l, anion gap >16 meq/l) in a sample of patients for whom the levels of ketone bodies in the blood and urine as well as serum electrolytes were available. RESULTS: We studied 355 hyperglycemic patients. The median time between arrival and dipstick testing was 21 min, and was greater than 2 h in more than 10% of cases. Comparison between ketonuria and ketonemia was performed in 173 patients (6% with diabetic ketoacidosis). Ketonuria equal to or less than one cross or a 3-beta-hydroxybutyrate value lower than 3 mmol/l enabled ketoacidosis to be excluded (negative predictive value 100%). At two-cross cutoff points for ketonuria and at the 3 mmol/l cutoff point for ketonemia, the two tests had the same sensitivity (100%), but the specificity of 3-beta-hydroxybutyrate (94%) was significantly higher (P<0.0001) than that of ketonuria (77%). The best positive predictive value for ketonemia was obtained at the 5 mmol/l cutoff point (100%) and for ketonuria at the three-cross cutoff point (26%). At the three-cross cutoff point for ketonuria and at the 5 mmol/l cutoff point for ketonemia, the two tests had the same negative likelihood ratio (0.1), but the positive likelihood ratio of 3-beta-hydroxybutyrate (infinite) was higher than that of ketonuria. CONCLUSION: The measurement of 3-beta-hydroxybutyrate in capillary blood is faster and more effective than the use of dipsticks in the urine to detect ketoacidosis in the Emergency Department setting. SN - 0969-9546 UR - https://www.unboundmedicine.com/medline/citation/15359197/Urinary_acetoacetate_or_capillary_beta_hydroxybutyrate_for_the_diagnosis_of_ketoacidosis_in_the_Emergency_Department_setting_ L2 - http://Insights.ovid.com/pubmed?pmid=15359197 DB - PRIME DP - Unbound Medicine ER -