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Diabetic Ketoacidosis in Adolescents and Children: A Prospective Study of Blood versus Urine Ketones in Monitoring Therapeutic Response.
Acta Med Indones 2018; 50(1):46-52AM

Abstract

BACKGROUND

diabetic ketoacidosis (DKA) is a potentially lethal complication of diabetes mellitus (DM). There is no study in Indonesia that compares the much-preferred capillary beta hydroxybutirate (β-OHB) measurement to urine acetoacetate in monitoring therapeutic response of DKA in adolescents.

METHODS

a prospective study of 37 adolescents and children with DKA in Cipto Mangunkusumo Hospital was done between June 2006 and March 2011. The patients were followed until the time of DKA resolution. Hourly measurement of random blood glucose, capillary β-OHB concentration, and urine ketones were done, while blood gas analysis and electrolyte were measured every four hours.

RESULTS

median time to resolution was 21 (9-52) hours. Compared to urine ketones, capillary β-OHB concentration showed stronger correlation with pH (r= -0,52, p= 0,003 vs r= -0,49, p= 0,005) and bicarbonate level (r=-0,60, p=0.000 vs r= -0.48, p=0.007) during the median time of DKA resolution. All capillary β-OHB measurement yielded negative results at median time of DKA resolution, while urine ketones were still detected up to 9 hours after resolution.

CONCLUSION

blood ketone concentration showed better correlation with pH and bicarbonate level, as a tool to monitor therapeutic response in DKA in adolescent, compared to traditional urine ketones test in adolescents.

Authors+Show Affiliations

Endocrinology Division, Department of Child Health, Faculty of Medicine, University of Indonesia-Cipto Mangunkusumo Hospital. amanpulungan@mac.com.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29686175

Citation

Pulungan, Aman Bhakti, et al. "Diabetic Ketoacidosis in Adolescents and Children: a Prospective Study of Blood Versus Urine Ketones in Monitoring Therapeutic Response." Acta Medica Indonesiana, vol. 50, no. 1, 2018, pp. 46-52.
Pulungan AB, Juwita E, Pudjiadi AH, et al. Diabetic Ketoacidosis in Adolescents and Children: A Prospective Study of Blood versus Urine Ketones in Monitoring Therapeutic Response. Acta Med Indones. 2018;50(1):46-52.
Pulungan, A. B., Juwita, E., Pudjiadi, A. H., Rahmayanti, S., & Tsaniya, I. (2018). Diabetic Ketoacidosis in Adolescents and Children: A Prospective Study of Blood versus Urine Ketones in Monitoring Therapeutic Response. Acta Medica Indonesiana, 50(1), pp. 46-52.
Pulungan AB, et al. Diabetic Ketoacidosis in Adolescents and Children: a Prospective Study of Blood Versus Urine Ketones in Monitoring Therapeutic Response. Acta Med Indones. 2018;50(1):46-52. PubMed PMID: 29686175.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diabetic Ketoacidosis in Adolescents and Children: A Prospective Study of Blood versus Urine Ketones in Monitoring Therapeutic Response. AU - Pulungan,Aman Bhakti, AU - Juwita,Erlin, AU - Pudjiadi,Antonius H, AU - Rahmayanti,Siti, AU - Tsaniya,Ireska, PY - 2018/4/25/entrez PY - 2018/4/25/pubmed PY - 2018/9/19/medline KW - capillary betahydroxybutirate KW - diabetic ketoacidosis KW - resolution time KW - urine ketones SP - 46 EP - 52 JF - Acta medica Indonesiana JO - Acta Med Indones VL - 50 IS - 1 N2 - BACKGROUND: diabetic ketoacidosis (DKA) is a potentially lethal complication of diabetes mellitus (DM). There is no study in Indonesia that compares the much-preferred capillary beta hydroxybutirate (β-OHB) measurement to urine acetoacetate in monitoring therapeutic response of DKA in adolescents. METHODS: a prospective study of 37 adolescents and children with DKA in Cipto Mangunkusumo Hospital was done between June 2006 and March 2011. The patients were followed until the time of DKA resolution. Hourly measurement of random blood glucose, capillary β-OHB concentration, and urine ketones were done, while blood gas analysis and electrolyte were measured every four hours. RESULTS: median time to resolution was 21 (9-52) hours. Compared to urine ketones, capillary β-OHB concentration showed stronger correlation with pH (r= -0,52, p= 0,003 vs r= -0,49, p= 0,005) and bicarbonate level (r=-0,60, p=0.000 vs r= -0.48, p=0.007) during the median time of DKA resolution. All capillary β-OHB measurement yielded negative results at median time of DKA resolution, while urine ketones were still detected up to 9 hours after resolution. CONCLUSION: blood ketone concentration showed better correlation with pH and bicarbonate level, as a tool to monitor therapeutic response in DKA in adolescent, compared to traditional urine ketones test in adolescents. SN - 0125-9326 UR - https://www.unboundmedicine.com/medline/citation/29686175/Diabetic_Ketoacidosis_in_Adolescents_and_Children:_A_Prospective_Study_of_Blood_versus_Urine_Ketones_in_Monitoring_Therapeutic_Response_ L2 - http://www.actamedindones.org/index.php/ijim/article/view/528/pdf DB - PRIME DP - Unbound Medicine ER -