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[Capillary beta-hydroxybutyrate determination for monitoring diabetic ketoacidosis].
Endocrinol Nutr 2011 Aug-Sep; 58(7):347-52EN

Abstract

BACKGROUND AND OBJECTIVE

Diabetic ketoacidosis (DKA) is the most severe acute metabolic complication of type 1 diabetes mellitus. Insulin treatment is commonly guided by plasma glucose levels and changes in venous blood gases, while β-hydroxibutyrate (BHB) levels are rarely measured. The study objective was to evaluate the value of capillary BHB monitoring in the course and resolution of DKA.

PATIENTS AND METHODS

Thirty patients with type 1 diabetes admitted for DKA were enrolled. A standard protocol including monitoring of blood glucose, venous blood gases, semiquantitative ketonuria, and capillary BHB was used. Patients were divided into three groups by time to DKA resolution (group 1:<24 h, group 2: 24-48 h, group 3: >48 h), and BHB results were compared to all other biochemical measurements.

RESULTS

Mean laboratory results upon admission were: blood glucose 415 (standard deviation [SD] 106) mg/dL; bicarbonate 9.6 (SD 1.5) mmol/L; pH 7.13 (SD 0.04); BHB 4.33 (SD 0.48) mmol/L, and ketonuria 3+ in 22 patients and 4+ in 6. BHB correlated well with bicarbonate (r=-0.24139; P=0.0161) and pH (r=-0.56419; P<0.0001). BHB normalized earlier than ketonuria in all cases (group 1: 15.5 vs 18.8 hours P<0.05; group 2: 18.2 vs 23.5 hours P<0.01; group 3: 37.3 vs 41.7 hours P<0.01). Ten percent of patients still had ketonuria when blood ketone levels were already normal (<0.5 mmol/L).

CONCLUSION

BHB measurement is an easy, practical, and reliable monitoring method in DKA and may be used as a parameter to adjust insulin treatment.

Authors+Show Affiliations

Servicio de Endocrinología, Hospital Universitari Vall d'Hebron, Barcelona, España.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

English Abstract
Journal Article

Language

spa

PubMed ID

21737365

Citation

Rodríguez-Merchán, Beatriz, et al. "[Capillary Beta-hydroxybutyrate Determination for Monitoring Diabetic Ketoacidosis]." Endocrinologia Y Nutricion : Organo De La Sociedad Espanola De Endocrinologia Y Nutricion, vol. 58, no. 7, 2011, pp. 347-52.
Rodríguez-Merchán B, Casteràs A, Domingo E, et al. [Capillary beta-hydroxybutyrate determination for monitoring diabetic ketoacidosis]. Endocrinol Nutr. 2011;58(7):347-52.
Rodríguez-Merchán, B., Casteràs, A., Domingo, E., Nóvoa, F. J., López, Y., Cabezas-Agricola, J. M., ... Mesa, J. (2011). [Capillary beta-hydroxybutyrate determination for monitoring diabetic ketoacidosis]. Endocrinologia Y Nutricion : Organo De La Sociedad Espanola De Endocrinologia Y Nutricion, 58(7), pp. 347-52. doi:10.1016/j.endonu.2011.05.003.
Rodríguez-Merchán B, et al. [Capillary Beta-hydroxybutyrate Determination for Monitoring Diabetic Ketoacidosis]. Endocrinol Nutr. 2011;58(7):347-52. PubMed PMID: 21737365.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Capillary beta-hydroxybutyrate determination for monitoring diabetic ketoacidosis]. AU - Rodríguez-Merchán,Beatriz, AU - Casteràs,Ana, AU - Domingo,Eva, AU - Nóvoa,Francisco José, AU - López,Yaiza, AU - Cabezas-Agricola,José Manuel, AU - Rivero,Teresa, AU - Parramón,Mónica, AU - Mesa,Jordi, Y1 - 2011/07/06/ PY - 2011/01/07/received PY - 2011/04/13/revised PY - 2011/05/05/accepted PY - 2011/7/9/entrez PY - 2011/7/9/pubmed PY - 2012/1/17/medline SP - 347 EP - 52 JF - Endocrinologia y nutricion : organo de la Sociedad Espanola de Endocrinologia y Nutricion JO - Endocrinol Nutr VL - 58 IS - 7 N2 - BACKGROUND AND OBJECTIVE: Diabetic ketoacidosis (DKA) is the most severe acute metabolic complication of type 1 diabetes mellitus. Insulin treatment is commonly guided by plasma glucose levels and changes in venous blood gases, while β-hydroxibutyrate (BHB) levels are rarely measured. The study objective was to evaluate the value of capillary BHB monitoring in the course and resolution of DKA. PATIENTS AND METHODS: Thirty patients with type 1 diabetes admitted for DKA were enrolled. A standard protocol including monitoring of blood glucose, venous blood gases, semiquantitative ketonuria, and capillary BHB was used. Patients were divided into three groups by time to DKA resolution (group 1:<24 h, group 2: 24-48 h, group 3: >48 h), and BHB results were compared to all other biochemical measurements. RESULTS: Mean laboratory results upon admission were: blood glucose 415 (standard deviation [SD] 106) mg/dL; bicarbonate 9.6 (SD 1.5) mmol/L; pH 7.13 (SD 0.04); BHB 4.33 (SD 0.48) mmol/L, and ketonuria 3+ in 22 patients and 4+ in 6. BHB correlated well with bicarbonate (r=-0.24139; P=0.0161) and pH (r=-0.56419; P<0.0001). BHB normalized earlier than ketonuria in all cases (group 1: 15.5 vs 18.8 hours P<0.05; group 2: 18.2 vs 23.5 hours P<0.01; group 3: 37.3 vs 41.7 hours P<0.01). Ten percent of patients still had ketonuria when blood ketone levels were already normal (<0.5 mmol/L). CONCLUSION: BHB measurement is an easy, practical, and reliable monitoring method in DKA and may be used as a parameter to adjust insulin treatment. SN - 1579-2021 UR - https://www.unboundmedicine.com/medline/citation/21737365/[Capillary_beta_hydroxybutyrate_determination_for_monitoring_diabetic_ketoacidosis]_ L2 - http://linkinghub.elsevier.com/retrieve/pii/S1575-0922(11)00197-5 DB - PRIME DP - Unbound Medicine ER -