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Evaluation of a portable meter to measure ketonemia and comparison with ketonuria for the diagnosis of canine diabetic ketoacidosis.
J Vet Intern Med. 2009 May-Jun; 23(3):466-71.JV

Abstract

BACKGROUND

The diagnosis of canine diabetic ketoacidosis (DKA) usually is based on measurement of urinary acetoacetate (ketonuria). In humans, this test is less sensitive and specific than blood 3-beta-hydroxybutyrate (ketonemia) evaluation.

HYPOTHESIS

Ketonemia measurement using a portable meter is more accurate than ketonuria determination with a dipstick to diagnose canine DKA.

ANIMALS

Seventy-two client-owned diabetic dogs with ketonemia, ketonuria, or both.

METHODS

Prospective observational study. Based on blood bicarbonate concentration and anion gap, dogs were divided into 2 groups: patients with DKA (n= 25); patients with diabetic ketosis (n= 47). Sensitivity, specificity, and positive and negative likelihood ratio (LR) at different cut-off points were determined for both ketonemia and ketonuria. Receiver operating characteristic (ROC) analysis was used to assess the accuracy of each diagnostic test to diagnose DKA.

RESULTS

With regard to ketonemia, cut-off values of 2.3 and 4.3 mmol/L revealed 100% sensitivity and 100% specificity, respectively, whereas cut-off values of 2.8 and 3.5 mmol/L showed a -LR of 0.05 and a + LR of 13.16, respectively. With regard to ketonuria, a cut-off value of 1+ revealed 92% sensitivity, 40% specificity, and -LR of 0.20, whereas a cut-off value of 3+ revealed 44% sensitivity, 94% specificity, and +LR of 6.89. The areas under the ROC curves for the ketonemia and ketonuria tests were significantly different (0.97 and 0.81, respectively, P= .003).

CONCLUSIONS AND CLINICAL IMPORTANCE

Measurement of ketonemia is accurate and more effective than measurement of ketonuria to diagnose canine DKA.

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  • Publisher Full Text

    • Authors+Show Affiliations

    Di Tommaso M
    Department of Veterinary Clinical Sciences, Faculty of Veterinary Medicine, University of Teramo, Teramo, Italy.
    Aste G
    No affiliation info available
    Rocconi F
    No affiliation info available
    Guglielmini C
    No affiliation info available
    Boari A
    No affiliation info available

    MeSH

    3-Hydroxybutyric AcidAnimalsDiabetic KetoacidosisDog DiseasesDogsFemaleKetonesMalePoint-of-Care SystemsSensitivity and Specificity

    Pub Type(s)

    Evaluation Study
    Journal Article

    Language

    eng

    PubMed ID

    19645834

    Citation

    Di Tommaso, M, et al. "Evaluation of a Portable Meter to Measure Ketonemia and Comparison With Ketonuria for the Diagnosis of Canine Diabetic Ketoacidosis." Journal of Veterinary Internal Medicine, vol. 23, no. 3, 2009, pp. 466-71.
    Di Tommaso M, Aste G, Rocconi F, et al. Evaluation of a portable meter to measure ketonemia and comparison with ketonuria for the diagnosis of canine diabetic ketoacidosis. J Vet Intern Med. 2009;23(3):466-71.
    Di Tommaso, M., Aste, G., Rocconi, F., Guglielmini, C., & Boari, A. (2009). Evaluation of a portable meter to measure ketonemia and comparison with ketonuria for the diagnosis of canine diabetic ketoacidosis. Journal of Veterinary Internal Medicine, 23(3), 466-71. https://doi.org/10.1111/j.1939-1676.2009.0302.x
    Di Tommaso M, et al. Evaluation of a Portable Meter to Measure Ketonemia and Comparison With Ketonuria for the Diagnosis of Canine Diabetic Ketoacidosis. J Vet Intern Med. 2009;23(3):466-71. PubMed PMID: 19645834.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Evaluation of a portable meter to measure ketonemia and comparison with ketonuria for the diagnosis of canine diabetic ketoacidosis. AU - Di Tommaso,M, AU - Aste,G, AU - Rocconi,F, AU - Guglielmini,C, AU - Boari,A, PY - 2009/8/4/entrez PY - 2009/8/4/pubmed PY - 2009/11/10/medline SP - 466 EP - 71 JF - Journal of veterinary internal medicine JO - J. Vet. Intern. Med. VL - 23 IS - 3 N2 - BACKGROUND: The diagnosis of canine diabetic ketoacidosis (DKA) usually is based on measurement of urinary acetoacetate (ketonuria). In humans, this test is less sensitive and specific than blood 3-beta-hydroxybutyrate (ketonemia) evaluation. HYPOTHESIS: Ketonemia measurement using a portable meter is more accurate than ketonuria determination with a dipstick to diagnose canine DKA. ANIMALS: Seventy-two client-owned diabetic dogs with ketonemia, ketonuria, or both. METHODS: Prospective observational study. Based on blood bicarbonate concentration and anion gap, dogs were divided into 2 groups: patients with DKA (n= 25); patients with diabetic ketosis (n= 47). Sensitivity, specificity, and positive and negative likelihood ratio (LR) at different cut-off points were determined for both ketonemia and ketonuria. Receiver operating characteristic (ROC) analysis was used to assess the accuracy of each diagnostic test to diagnose DKA. RESULTS: With regard to ketonemia, cut-off values of 2.3 and 4.3 mmol/L revealed 100% sensitivity and 100% specificity, respectively, whereas cut-off values of 2.8 and 3.5 mmol/L showed a -LR of 0.05 and a + LR of 13.16, respectively. With regard to ketonuria, a cut-off value of 1+ revealed 92% sensitivity, 40% specificity, and -LR of 0.20, whereas a cut-off value of 3+ revealed 44% sensitivity, 94% specificity, and +LR of 6.89. The areas under the ROC curves for the ketonemia and ketonuria tests were significantly different (0.97 and 0.81, respectively, P= .003). CONCLUSIONS AND CLINICAL IMPORTANCE: Measurement of ketonemia is accurate and more effective than measurement of ketonuria to diagnose canine DKA. SN - 0891-6640 UR - https://www.unboundmedicine.com/medline/citation/19645834/Evaluation_of_a_portable_meter_to_measure_ketonemia_and_comparison_with_ketonuria_for_the_diagnosis_of_canine_diabetic_ketoacidosis_ L2 - https://doi.org/10.1111/j.1939-1676.2009.0302.x DB - PRIME DP - Unbound Medicine ER -