Value of point-of-care ketones in assessing dehydration and acidosis in children with gastroenteritis.
OBJECTIVE
Children with gastroenteritis often develop dehydration with metabolic acidosis. Serum ketones are frequently elevated in this population. The goal was to determine the relationship between initial serum ketone concentration and both the degree of dehydration and the magnitude of acidosis.


METHODS
This was a secondary analysis of a prospective trial of crystalloid administration for rapid rehydration. Children 6 months to 6 years of age with gastroenteritis and dehydration were enrolled. A point-of-care serum ketone (beta-hydroxybutyrate) concentration was obtained at the time of study enrollment. The relationship between initial serum ketone concentration and a prospectively assigned and previously validated clinical dehydration score, and serum bicarbonate concentration, was analyzed.


RESULTS
A total of 188 patients were enrolled. The median serum ketone concentration was elevated at 3.1 mmol/L (interquartile range [IQR] = 1.2 to 4.6 mmol/L), and the median dehydration score was consistent with moderate dehydration. A significant positive relationship was found between serum ketone concentration and the clinical dehydration score (Spearman's rho = 0.22, p = 0.003). Patients with moderate dehydration had a higher median serum ketone concentration than those with mild dehydration (3.6 mmol/L vs. 1.4 mmol/L, p = 0.007). Additionally, the serum ketone concentration was inversely correlated with serum bicarbonate concentration (ρ = -0.26, p < 0.001).


CONCLUSIONS
Children with gastroenteritis and dehydration have elevated serum ketone concentrations that correlate with both degree of dehydration and magnitude of metabolic acidosis. Point-of-care serum ketone measurement may be a useful tool to inform management decisions at the point of triage or in the initial evaluation of children with gastroenteritis and dehydration.
Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA.
Jason A
JA
Levy
Mark
M
Waltzman
Michael C
MC
Monuteaux
Richard G
RG
Bachur
D000138:Acidosis / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D003681:Dehydration / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D004311:Double-Blind Method; D005260:Female; D005440:Fluid Therapy / Q000379:methods; D005759:Gastroenteritis / Q000150:complications*; D005947:Glucose / Q000627:therapeutic use; D006786:Hospitals, Urban; D006801:Humans; D007223:Infant; D007659:Ketones / Q000097:blood*; D008297:Male; D019095:Point-of-Care Systems; D011446:Prospective Studies; D014218:Triage
D015415:Biomarkers; D001786:Blood Glucose; D007659:Ketones; D005947:Glucose