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Point-of-care blood ketone testing: screening for diabetic ketoacidosis at the emergency department.
Singapore Med J 2007; 48(11):986-9SM

Abstract

INTRODUCTION

We piloted the use of a blood beta-hydroxybutyrate meter as a point-of-care testing in an emergency department (ED) to establish its role in distinguishing ketosis/ketoacidosis from simple hyperglycaemia, and develop guidelines for its use in the ED.

METHODS

111 consecutive patients presenting with capillary glucose levels exceeding 14 mmol/L had a simultaneous blood ketone measurement at triage. This was correlated with clinical diagnosis, venous bicarbonate levels and urine ketone testing.

RESULTS

The median beta-hydroxybutyrate levels was 5.7 (range 4.3-6.0) mmol/L for patients with diabetic ketoacidosis (DKA) and 0.1 (0.0-3.2) mmol/L for the remaining patients. Only 47.7 percent could provide urine samples in the ED. A blood ketone result of 3.5 mmol/L yielded 100 percent specificity and sensitivity for the diagnosis of DKA.

CONCLUSION

This is a useful tool that allows clinicians to immediately distinguish between simple hyperglycaemia and potentially life-threatening ketotic states. We formulated simple guidelines for its utilisation in an ED setting.

Authors+Show Affiliations

Department of Emergency Medicine, Singapore General Hospital, Outram Road, Singapore 169608. rabindcharles@yahoo.com.sgNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17975686

Citation

Charles, R A., et al. "Point-of-care Blood Ketone Testing: Screening for Diabetic Ketoacidosis at the Emergency Department." Singapore Medical Journal, vol. 48, no. 11, 2007, pp. 986-9.
Charles RA, Bee YM, Eng PH, et al. Point-of-care blood ketone testing: screening for diabetic ketoacidosis at the emergency department. Singapore Med J. 2007;48(11):986-9.
Charles, R. A., Bee, Y. M., Eng, P. H., & Goh, S. Y. (2007). Point-of-care blood ketone testing: screening for diabetic ketoacidosis at the emergency department. Singapore Medical Journal, 48(11), pp. 986-9.
Charles RA, et al. Point-of-care Blood Ketone Testing: Screening for Diabetic Ketoacidosis at the Emergency Department. Singapore Med J. 2007;48(11):986-9. PubMed PMID: 17975686.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Point-of-care blood ketone testing: screening for diabetic ketoacidosis at the emergency department. AU - Charles,R A, AU - Bee,Y M, AU - Eng,P H K, AU - Goh,S Y, PY - 2007/11/3/pubmed PY - 2008/1/8/medline PY - 2007/11/3/entrez SP - 986 EP - 9 JF - Singapore medical journal JO - Singapore Med J VL - 48 IS - 11 N2 - INTRODUCTION: We piloted the use of a blood beta-hydroxybutyrate meter as a point-of-care testing in an emergency department (ED) to establish its role in distinguishing ketosis/ketoacidosis from simple hyperglycaemia, and develop guidelines for its use in the ED. METHODS: 111 consecutive patients presenting with capillary glucose levels exceeding 14 mmol/L had a simultaneous blood ketone measurement at triage. This was correlated with clinical diagnosis, venous bicarbonate levels and urine ketone testing. RESULTS: The median beta-hydroxybutyrate levels was 5.7 (range 4.3-6.0) mmol/L for patients with diabetic ketoacidosis (DKA) and 0.1 (0.0-3.2) mmol/L for the remaining patients. Only 47.7 percent could provide urine samples in the ED. A blood ketone result of 3.5 mmol/L yielded 100 percent specificity and sensitivity for the diagnosis of DKA. CONCLUSION: This is a useful tool that allows clinicians to immediately distinguish between simple hyperglycaemia and potentially life-threatening ketotic states. We formulated simple guidelines for its utilisation in an ED setting. SN - 0037-5675 UR - https://www.unboundmedicine.com/medline/citation/17975686/Point_of_care_blood_ketone_testing:_screening_for_diabetic_ketoacidosis_at_the_emergency_department_ L2 - http://smj.sma.org.sg/4811/4811a1.pdf DB - PRIME DP - Unbound Medicine ER -