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.
Vanelli
M
M
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
Chiari
G
G
Capuano
C
C
Iovane
B
B
Bernardini
A
A
Giacalone
T
T
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