Can Serum β-Hydroxybutyrate Be Used to Diagnose Diabetic Ketoacidosis?

  1. Mae Sheikh-Ali, MD15,
  2. Brad S. Karon, MD, PHD2,
  3. Ananda Basu, MB, BS1,
  4. Yogish C. Kudva, MB, BS1,
  5. Lisa A. Muller, BA3,
  6. Jia Xu, MS3,
  7. W. Frederick Schwenk, MD14 and
  8. John M. Miles, MD1
  1. 1Division of Endocrinology, Diabetes, Nutrition, and Metabolism, Mayo Clinic, Rochester, Minnesota
  2. 2Division of Laboratory Medicine, Mayo Clinic, Rochester, Minnesota
  3. 3Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota
  4. 4Division of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
  5. 5Mayo Clinic, Jacksonville, Florida
  1. Address correspondence and reprint requests to John M. Miles, MD, Endocrine Research Unit, Mayo Clinic, 200 First St. SW, Rochester, MN 55905. E-mail: miles.john{at}mayo.edu

Abstract

OBJECTIVE—Current criteria for the diagnosis of diabetic ketoacidosis (DKA) are limited by their nonspecificity (serum bicarbonate [HCO3] and pH) and qualitative nature (the presence of ketonemia/ketonuria). The present study was undertaken to determine whether quantitative measurement of a ketone body anion could be used to diagnose DKA.

RESEARCH DESIGN AND METHODS—A retrospective review of records from hospitalized diabetic patients was undertaken to determine the concentration of serum β-hydroxybutyrate (βOHB) that corresponds to a HCO3 level of 18 mEq/l, the threshold value for diagnosis in recently published consensus criteria. Simultaneous admission βOHB and HCO3 values were recorded from 466 encounters, 129 in children and 337 in adults.

RESULTS—A HCO3 level of 18 mEq/l corresponded with βOHB levels of 3.0 and 3.8 mmol/l in children and adults, respectively. With the use of these threshold βOHB values to define DKA, there was substantial discordance (∼≥20%) between βOHB and conventional diagnostic criteria using HCO3, pH, and glucose. In patients with DKA, there was no correlation between HCO3 and glucose levels on admission and a significant but weak correlation between βOHB and glucose levels (P < 0.001).

CONCLUSIONS—Where available, serum βOHB levels ≥3.0 and ≥3.8 mmol/l in children and adults, respectively, in the presence of uncontrolled diabetes can be used to diagnose DKA and may be superior to the serum HCO3 level for that purpose. The marked variability in the relationship between βOHB and HCO3 is probably due to the presence of other acid-base disturbances, especially hyperchloremic, nonanion gap acidosis.

Footnotes

  • Published ahead of print at http://care.diabetesjournals.org on 9 January 2008. DOI: 10.2337/dc07-1683.

    Additional information for this article can be found in an online appendix at http://dx.doi.org/10.2337/dc07-1683.

    The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C Section 1734 solely to indicate this fact.

    • Accepted December 22, 2007.
    • Received August 27, 2007.
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  1. Published online before print January 9, 2008, doi: 10.2337/dc07-1683 Diabetes Care April 2008 vol. 31 no. 4 643-647
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