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Bedside monitoring of blood beta-hydroxybutyrate levels in the management of diabetic ketoacidosis in children.
Diabetes Technol Ther 2006; 8(6):671-6DT

Abstract

INTRODUCTION

Diabetic ketoacidosis (DKA) affects many children with type 1 diabetes. Insulin treatment of DKA is traditionally guided by changes in the blood glucose levels and blood gases, whereas beta-hydroxybutyrate (beta-OHB)--the main ketoacid causing acidosis--is rarely measured. The purpose of this study was to evaluate if bedside monitoring of blood beta-OHB levels can simplify management of DKA through elimination of superfluous laboratory monitoring.

METHODS

Our emergency department treated 68 children with DKA using a standard protocol with monitoring of venous pH, partial pressure of CO(2) (pCO(2)), bicarbonate, glucose, blood urea nitrogen, and electrolytes (two to 10 time points per patient). Venous beta-OHB levels were measured using the Precision Xtra meter (MediSense/Abbott Diabetes Care, Abbott Park, IL) and, on duplicate batched serum samples, using a reference laboratory method (Cobas Mira Plus; Roche Diagnostics, Indianapolis, IN). Correlations between bedside meter beta-OHB and other parameters were evaluated in a series of general linear models with a time series covariance structure fit using spatial power law.

RESULTS

The bedside meter beta-OHB levels were significantly correlated with pH (r = -0.63; P <0.0001), bicarbonate (r = -0.74; P <0.0001), and pCO(2) (r = -0.55; P <0.0001) at all points of measurement during the treatment (unadjusted Pearson correlations). The pH, bicarbonate, and pCO(2) were entered into separate time series analysis models with treatment duration as a measure of time. The results confirmed that bedside levels of beta-OHB correlated very closely with time-dependent levels of venous pH, bicarbonate, and pCO(2). Good agreement between the two methods of beta-OHB measurement (r = 0.92; P <0.0001) was confirmed using the Bland-Altman plot analysis.

CONCLUSIONS

The Precision Xtra accurately measures blood beta-OHB levels, particularly at lower levels. While the initial measurement of pH and/or bicarbonates is warranted, real-time beta-OHB levels may replace repeat laboratory measurement of these parameters in the management of DKA. Future studies should evaluate safety and cost-effectiveness of such simplified DKA treatment protocol.

Authors+Show Affiliations

Pediatric Emergency Medicine, Department of Pediatrics, University of Colorado at Denver and Health Sciences Center, Denver, Colorado 80218, USA. rewers.arleta@tchden.orgNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Validation Study

Language

eng

PubMed ID

17109599

Citation

Rewers, Arleta, et al. "Bedside Monitoring of Blood Beta-hydroxybutyrate Levels in the Management of Diabetic Ketoacidosis in Children." Diabetes Technology & Therapeutics, vol. 8, no. 6, 2006, pp. 671-6.
Rewers A, McFann K, Chase HP. Bedside monitoring of blood beta-hydroxybutyrate levels in the management of diabetic ketoacidosis in children. Diabetes Technol Ther. 2006;8(6):671-6.
Rewers, A., McFann, K., & Chase, H. P. (2006). Bedside monitoring of blood beta-hydroxybutyrate levels in the management of diabetic ketoacidosis in children. Diabetes Technology & Therapeutics, 8(6), pp. 671-6.
Rewers A, McFann K, Chase HP. Bedside Monitoring of Blood Beta-hydroxybutyrate Levels in the Management of Diabetic Ketoacidosis in Children. Diabetes Technol Ther. 2006;8(6):671-6. PubMed PMID: 17109599.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Bedside monitoring of blood beta-hydroxybutyrate levels in the management of diabetic ketoacidosis in children. AU - Rewers,Arleta, AU - McFann,Kim, AU - Chase,H Peter, PY - 2006/11/18/pubmed PY - 2007/2/13/medline PY - 2006/11/18/entrez SP - 671 EP - 6 JF - Diabetes technology & therapeutics JO - Diabetes Technol. Ther. VL - 8 IS - 6 N2 - INTRODUCTION: Diabetic ketoacidosis (DKA) affects many children with type 1 diabetes. Insulin treatment of DKA is traditionally guided by changes in the blood glucose levels and blood gases, whereas beta-hydroxybutyrate (beta-OHB)--the main ketoacid causing acidosis--is rarely measured. The purpose of this study was to evaluate if bedside monitoring of blood beta-OHB levels can simplify management of DKA through elimination of superfluous laboratory monitoring. METHODS: Our emergency department treated 68 children with DKA using a standard protocol with monitoring of venous pH, partial pressure of CO(2) (pCO(2)), bicarbonate, glucose, blood urea nitrogen, and electrolytes (two to 10 time points per patient). Venous beta-OHB levels were measured using the Precision Xtra meter (MediSense/Abbott Diabetes Care, Abbott Park, IL) and, on duplicate batched serum samples, using a reference laboratory method (Cobas Mira Plus; Roche Diagnostics, Indianapolis, IN). Correlations between bedside meter beta-OHB and other parameters were evaluated in a series of general linear models with a time series covariance structure fit using spatial power law. RESULTS: The bedside meter beta-OHB levels were significantly correlated with pH (r = -0.63; P <0.0001), bicarbonate (r = -0.74; P <0.0001), and pCO(2) (r = -0.55; P <0.0001) at all points of measurement during the treatment (unadjusted Pearson correlations). The pH, bicarbonate, and pCO(2) were entered into separate time series analysis models with treatment duration as a measure of time. The results confirmed that bedside levels of beta-OHB correlated very closely with time-dependent levels of venous pH, bicarbonate, and pCO(2). Good agreement between the two methods of beta-OHB measurement (r = 0.92; P <0.0001) was confirmed using the Bland-Altman plot analysis. CONCLUSIONS: The Precision Xtra accurately measures blood beta-OHB levels, particularly at lower levels. While the initial measurement of pH and/or bicarbonates is warranted, real-time beta-OHB levels may replace repeat laboratory measurement of these parameters in the management of DKA. Future studies should evaluate safety and cost-effectiveness of such simplified DKA treatment protocol. SN - 1520-9156 UR - https://www.unboundmedicine.com/medline/citation/17109599/Bedside_monitoring_of_blood_beta_hydroxybutyrate_levels_in_the_management_of_diabetic_ketoacidosis_in_children_ L2 - https://www.liebertpub.com/doi/full/10.1089/dia.2006.8.671?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -