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Point-of-care test identifies diabetic ketoacidosis at triage.
Acad Emerg Med 2006; 13(6):683-5AE

Abstract

BACKGROUND

Diabetic ketoacidosis (DKA) is a common, life-threatening complication of diabetes. The diagnosis of DKA relies on signs and symptoms, plus laboratory findings of blood glucose (BG) of > 250 mg/dL, an anion gap (AG) of > or = 15 mmol/L, and carbon dioxide (CO2) of < or = 18 mmol/L when other causes of acidosis are excluded.

OBJECTIVES

To compare the results of a point-of-care test for the ketone beta-hydroxybutyrate (beta-OHB) with standard measures for accuracy in predicting DKA.

METHODS

After providing informed consent, 160 patients who presented with BG of > 250 mg/dL underwent testing for beta-OHB with the Precision Xtra meter (Abbott Laboratories, North Chicago, IL) at triage in a large urban hospital emergency department. The diagnosis of DKA was made by clinicians by using standard clinical criteria without knowledge of the beta-OHB test.

RESULTS

A diagnosis of DKA was made in 57 of 160 subjects. The beta-OHB values correlated strongly with AG (r = 0.66, p < 0.001) and with CO2 (r = -0.69, p < 0.001), as well as with glucose (r = 0.31, p < 0.001). Cross-classification of DKA vs. beta-OHB yielded sensitivity of 98% (95% CI = 91% to 100%), specificity of 85% (95% CI = 78% to 91%), with a positive likelihood ratio of 6.7 (95% CI = 4.22 to 10.78), and negative likelihood ratio of 0.021 (95% CI = 0.003 to 0.144) at the manufacturer-suggested beta-OHB level of 1.5.

CONCLUSIONS

The point-of-care test for beta-OHB was as sensitive as more established indicators of DKA. It is more useful than glucose alone for the diagnosis of DKA and offers immediate diagnosis of patients at triage.

Authors+Show Affiliations

Department of Emergency Medicine, Washington University, St. Louis, MO, USA. naunheir@msnotes.wustl.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Validation Studies

Language

eng

PubMed ID

16690813

Citation

Naunheim, Rosanne, et al. "Point-of-care Test Identifies Diabetic Ketoacidosis at Triage." Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, vol. 13, no. 6, 2006, pp. 683-5.
Naunheim R, Jang TJ, Banet G, et al. Point-of-care test identifies diabetic ketoacidosis at triage. Acad Emerg Med. 2006;13(6):683-5.
Naunheim, R., Jang, T. J., Banet, G., Richmond, A., & McGill, J. (2006). Point-of-care test identifies diabetic ketoacidosis at triage. Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, 13(6), pp. 683-5.
Naunheim R, et al. Point-of-care Test Identifies Diabetic Ketoacidosis at Triage. Acad Emerg Med. 2006;13(6):683-5. PubMed PMID: 16690813.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Point-of-care test identifies diabetic ketoacidosis at triage. AU - Naunheim,Rosanne, AU - Jang,Timothy J, AU - Banet,Gerald, AU - Richmond,Alec, AU - McGill,Janet, Y1 - 2006/05/11/ PY - 2006/5/13/pubmed PY - 2006/7/29/medline PY - 2006/5/13/entrez SP - 683 EP - 5 JF - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine JO - Acad Emerg Med VL - 13 IS - 6 N2 - BACKGROUND: Diabetic ketoacidosis (DKA) is a common, life-threatening complication of diabetes. The diagnosis of DKA relies on signs and symptoms, plus laboratory findings of blood glucose (BG) of > 250 mg/dL, an anion gap (AG) of > or = 15 mmol/L, and carbon dioxide (CO2) of < or = 18 mmol/L when other causes of acidosis are excluded. OBJECTIVES: To compare the results of a point-of-care test for the ketone beta-hydroxybutyrate (beta-OHB) with standard measures for accuracy in predicting DKA. METHODS: After providing informed consent, 160 patients who presented with BG of > 250 mg/dL underwent testing for beta-OHB with the Precision Xtra meter (Abbott Laboratories, North Chicago, IL) at triage in a large urban hospital emergency department. The diagnosis of DKA was made by clinicians by using standard clinical criteria without knowledge of the beta-OHB test. RESULTS: A diagnosis of DKA was made in 57 of 160 subjects. The beta-OHB values correlated strongly with AG (r = 0.66, p < 0.001) and with CO2 (r = -0.69, p < 0.001), as well as with glucose (r = 0.31, p < 0.001). Cross-classification of DKA vs. beta-OHB yielded sensitivity of 98% (95% CI = 91% to 100%), specificity of 85% (95% CI = 78% to 91%), with a positive likelihood ratio of 6.7 (95% CI = 4.22 to 10.78), and negative likelihood ratio of 0.021 (95% CI = 0.003 to 0.144) at the manufacturer-suggested beta-OHB level of 1.5. CONCLUSIONS: The point-of-care test for beta-OHB was as sensitive as more established indicators of DKA. It is more useful than glucose alone for the diagnosis of DKA and offers immediate diagnosis of patients at triage. SN - 1553-2712 UR - https://www.unboundmedicine.com/medline/citation/16690813/Point_of_care_test_identifies_diabetic_ketoacidosis_at_triage_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&amp;sid=nlm:pubmed&amp;issn=1069-6563&amp;date=2006&amp;volume=13&amp;issue=6&amp;spage=683 DB - PRIME DP - Unbound Medicine ER -