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Utility of ketone measurement in the prevention, diagnosis and management of diabetic ketoacidosis.
Diabet Med. 2015 Jan; 32(1):14-23.DM

Abstract

Ketone measurement is advocated for the diagnosis of diabetic ketoacidosis and assessment of its severity. Assessing the evidence base for ketone measurement in clinical practice is challenging because multiple methods are available but there is a lack of consensus about which is preferable. Evaluating the utility of ketone measurement is additionally problematic because of variability in the biochemical definition of ketoacidosis internationally and in the proposed thresholds for ketone measures. This has led to conflicting guidance from expert bodies on how ketone measurement should be used in the management of ketoacidosis. The development of point-of-care devices that can reliably measure the capillary blood ketone β-hydroxybutyrate (BOHB) has widened the spectrum of applications of ketone measurement, but whether the evidence base supporting these applications is robust enough to warrant their incorporation into routine clinical practice remains unclear. The imprecision of capillary blood ketone measures at higher values, the lack of availability of routine laboratory-based assays for BOHB and the continued cost-effectiveness of urine ketone assessment prompt further discussion on the role of capillary blood ketone assessment in ketoacidosis. In the present article, we review the various existing methods of ketone measurement, the precision of capillary blood ketone as compared with other measures, its diagnostic accuracy in predicting ketoacidosis and other clinical applications including prevention, assessment of severity and resolution of ketoacidosis.

Authors+Show Affiliations

Department of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK; Clincal Biochemistry and Metabolic Medicine, Imperial Healthcare NHS Trust, London, UK.No affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

25307274

Citation

Misra, S, and N S. Oliver. "Utility of Ketone Measurement in the Prevention, Diagnosis and Management of Diabetic Ketoacidosis." Diabetic Medicine : a Journal of the British Diabetic Association, vol. 32, no. 1, 2015, pp. 14-23.
Misra S, Oliver NS. Utility of ketone measurement in the prevention, diagnosis and management of diabetic ketoacidosis. Diabet Med. 2015;32(1):14-23.
Misra, S., & Oliver, N. S. (2015). Utility of ketone measurement in the prevention, diagnosis and management of diabetic ketoacidosis. Diabetic Medicine : a Journal of the British Diabetic Association, 32(1), 14-23. https://doi.org/10.1111/dme.12604
Misra S, Oliver NS. Utility of Ketone Measurement in the Prevention, Diagnosis and Management of Diabetic Ketoacidosis. Diabet Med. 2015;32(1):14-23. PubMed PMID: 25307274.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Utility of ketone measurement in the prevention, diagnosis and management of diabetic ketoacidosis. AU - Misra,S, AU - Oliver,N S, Y1 - 2014/11/19/ PY - 2014/03/25/received PY - 2014/07/10/revised PY - 2014/10/06/accepted PY - 2014/10/14/entrez PY - 2014/10/14/pubmed PY - 2015/8/12/medline SP - 14 EP - 23 JF - Diabetic medicine : a journal of the British Diabetic Association JO - Diabet. Med. VL - 32 IS - 1 N2 - Ketone measurement is advocated for the diagnosis of diabetic ketoacidosis and assessment of its severity. Assessing the evidence base for ketone measurement in clinical practice is challenging because multiple methods are available but there is a lack of consensus about which is preferable. Evaluating the utility of ketone measurement is additionally problematic because of variability in the biochemical definition of ketoacidosis internationally and in the proposed thresholds for ketone measures. This has led to conflicting guidance from expert bodies on how ketone measurement should be used in the management of ketoacidosis. The development of point-of-care devices that can reliably measure the capillary blood ketone β-hydroxybutyrate (BOHB) has widened the spectrum of applications of ketone measurement, but whether the evidence base supporting these applications is robust enough to warrant their incorporation into routine clinical practice remains unclear. The imprecision of capillary blood ketone measures at higher values, the lack of availability of routine laboratory-based assays for BOHB and the continued cost-effectiveness of urine ketone assessment prompt further discussion on the role of capillary blood ketone assessment in ketoacidosis. In the present article, we review the various existing methods of ketone measurement, the precision of capillary blood ketone as compared with other measures, its diagnostic accuracy in predicting ketoacidosis and other clinical applications including prevention, assessment of severity and resolution of ketoacidosis. SN - 1464-5491 UR - https://www.unboundmedicine.com/medline/citation/25307274/Utility_of_ketone_measurement_in_the_prevention_diagnosis_and_management_of_diabetic_ketoacidosis_ L2 - https://doi.org/10.1111/dme.12604 DB - PRIME DP - Unbound Medicine ER -