Point-of-care blood ketone testing: screening for diabetic ketoacidosis at the emergency department.
BACKGROUND
We piloted the use of a blood beta-hydroxybutyrate meter as a point-of-care testing in an emergency department (ED) to establish its role in distinguishing ketosis/ketoacidosis from simple hyperglycaemia, and develop guidelines for its use in the ED.


METHODS
111 consecutive patients presenting with capillary glucose levels exceeding 14 mmol/L had a simultaneous blood ketone measurement at triage. This was correlated with clinical diagnosis, venous bicarbonate levels and urine ketone testing.


RESULTS
The median beta-hydroxybutyrate levels was 5.7 (range 4.3-6.0) mmol/L for patients with diabetic ketoacidosis (DKA) and 0.1 (0.0-3.2) mmol/L for the remaining patients. Only 47.7 percent could provide urine samples in the ED. A blood ketone result of 3.5 mmol/L yielded 100 percent specificity and sensitivity for the diagnosis of DKA.


CONCLUSIONS
This is a useful tool that allows clinicians to immediately distinguish between simple hyperglycaemia and potentially life-threatening ketotic states. We formulated simple guidelines for its utilisation in an ED setting.
Charles
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RA
Department of Emergency Medicine, Singapore General Hospital, Outram Road, Singapore 169608. rabindcharles@yahoo.com.sg
Bee
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Eng
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Goh
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D020155:3-Hydroxybutyric Acid / Q000097:blood; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001639:Bicarbonates / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D016883:Diabetic Ketoacidosis / Q000097:blood / Q000175:diagnosis*; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000175:diagnosis; D007657:Ketone Bodies / Q000097:blood*; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D010865:Pilot Projects; D019095:Point-of-Care Systems; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D012846:Singapore; D014218:Triage
D001639:Bicarbonates; D001786:Blood Glucose; D007657:Ketone Bodies; D020155:3-Hydroxybutyric Acid