title: [Capillary beta-hydroxybutyrate determination for monitoring diabetic ketoacidosis].
abstract: OBJECTIVE
  Diabetic ketoacidosis (DKA) is the most severe acute metabolic complication of type 1 diabetes mellitus. Insulin treatment is commonly guided by plasma glucose levels and changes in venous blood gases, while β-hydroxibutyrate (BHB) levels are rarely measured. The study objective was to evaluate the value of capillary BHB monitoring in the course and resolution of DKA.
  
  
  METHODS
  Thirty patients with type 1 diabetes admitted for DKA were enrolled. A standard protocol including monitoring of blood glucose, venous blood gases, semiquantitative ketonuria, and capillary BHB was used. Patients were divided into three groups by time to DKA resolution (group 1:<24 h, group 2: 24-48 h, group 3: >48 h), and BHB results were compared to all other biochemical measurements.
  
  
  RESULTS
  Mean laboratory results upon admission were: blood glucose 415 (standard deviation [SD] 106) mg/dL; bicarbonate 9.6 (SD 1.5) mmol/L; pH 7.13 (SD 0.04); BHB 4.33 (SD 0.48) mmol/L, and ketonuria 3+ in 22 patients and 4+ in 6. BHB correlated well with bicarbonate (r=-0.24139; P=0.0161) and pH (r=-0.56419; P<0.0001). BHB normalized earlier than ketonuria in all cases (group 1: 15.5 vs 18.8 hours P<0.05; group 2: 18.2 vs 23.5 hours P<0.01; group 3: 37.3 vs 41.7 hours P<0.01). Ten percent of patients still had ketonuria when blood ketone levels were already normal (<0.5 mmol/L).
  
  
  CONCLUSIONS
  BHB measurement is an easy, practical, and reliable monitoring method in DKA and may be used as a parameter to adjust insulin treatment.
authors: Servicio de Endocrinología, Hospital Universitari Vall d'Hebron, Barcelona, España.
authors: Beatriz
authors: B
authors: Rodríguez-Merchán
authors: Ana
authors: A
authors: Casteràs
authors: Eva
authors: E
authors: Domingo
authors: Francisco José
authors: FJ
authors: Nóvoa
authors: Yaiza
authors: Y
authors: López
authors: José Manuel
authors: JM
authors: Cabezas-Agricola
authors: Teresa
authors: T
authors: Rivero
authors: Mónica
authors: M
authors: Parramón
authors: Jordi
authors: J
authors: Mesa
mesh_terms: D020155:3-Hydroxybutyric Acid / Q000097:blood*; D000328:Adult; D002196:Capillaries; D016883:Diabetic Ketoacidosis / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male
chemical_list: D020155:3-Hydroxybutyric Acid