The direct measurement of 3-beta-hydroxy butyrate enhances the management of diabetic ketoacidosis in children and reduces time and costs of treatment.
In this study the effectiveness of a quantitative test of beta-hydroxybutyrate (beta-HBA) against a commercial test for urine ketone bodies (UKB) in monitoring diabetic ketoacidosis (DKA) was evaluated to verify whether this ketone-testing method was able to reduce the monitoring costs and professional burden of nurses and physicians. Thirty-three children with severe (arterial pH < or = 7.2) or moderate (7.2 < pH < or = 7.3) DKA were studied. Sixteen patients were randomly monitored with blood beta-HBA (group 1) and 17 by UKB (group 2). Contrary to UKB, beta-HBA levels appeared correlated with: HbA1c values on admission (r = 0.99; p = 0.0001); latent period before diagnosis of diabetes (r = 0.95; p = 0.0001); changes in arterial pH (r = -0.82; p = 0.0001) and blood bicarbonate values (r = -0.63; p = 0.001) during the treatment for DKA. Required time to achieve the resolution of ketosis in group 1 patients was related to the values of beta-HBA on admission (r = 0.84; p < 0.001). Determination of beta-HBA showed that ketosis in group 1 patients cleared 4 to 9.5 hours earlier than in group 2. Due to this early normalization, the patients of group 1 left the Intensive Care Unit 6.5 +/- 1.5 hr earlier than those of group 2. This led to 22 hr saved for clinical assessment and 375 laboratory investigations for a total saving of 2940 euros including costs for laboratory tests (29.8%) and clinical assessment (70.2%). Quantitative determination of beta-HBA levels seems to offer useful information for monitoring DKA in newly-diagnosed diabetic children and for reducing time and costs in an Intensive Care Unit.
Department of Pediatrics, Chair of Pediatrics, Regional Diabetes Centre for Children and Adolescents, University of Parma, V.le A. Gramsci 14, I-43100 Parma, Italy. vanelli@unipr.it
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Vanelli
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Chiari
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Capuano
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Iovane
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Bernardini
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Giacalone
D020155:3-Hydroxybutyric Acid / Q000097:blood*; D001786:Blood Glucose / Q000032:analysis; D002648:Child; D003362:Cost-Benefit Analysis; D003422:Critical Care / Q000191:economics*; D016883:Diabetic Ketoacidosis / Q000097:blood / Q000175:diagnosis* / Q000652:urine; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007657:Ketone Bodies / Q000652:urine*; D008297:Male; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D013997:Time Factors
D020155:3-Hydroxybutyric Acid; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007657:Ketone Bodies