Blood ketones: Measurement, interpretation, limitations, and utility in the management of diabetic ketoacidosis

Review of Diabetic Studies

Volumn 13, Issue 4, 2016, Pages 217-225

  Dhatariya, Ketan ^a  

^a NORFOLK AND NORWICH UNIVERSITY HOSPITAL   (United Kingdom)

Author keywords

Diabetes; Diabetic ketoacidosis; Glucose uptake; Ketones; Measurement; SGLT 2

Indexed keywords

3 HYDROXYBUTYRIC ACID; ACETOACETIC ACID; GLUCOSE; KETONE; SODIUM GLUCOSE COTRANSPORTER 2; SODIUM GLUCOSE COTRANSPORTER 2 INHIBITOR; KETONE BODY;

BLOOD ANALYSIS EQUIPMENT; BLOOD KETONE METER; COST; DIABETIC KETOACIDOSIS; GLUCOSE TRANSPORT; HUMAN; INSULIN DEPENDENT DIABETES MELLITUS; INSULIN INFUSION; KETOGENESIS; LENGTH OF STAY; MEDICAL DECISION MAKING; NON INSULIN DEPENDENT DIABETES MELLITUS; POINT OF CARE TESTING; PRACTICE GUIDELINE; PREVALENCE; QUALITY CONTROL; REVIEW; SENSITIVITY AND SPECIFICITY; URINALYSIS; BLOOD; ECONOMICS; EMERGENCY HEALTH SERVICE; EPIDEMIOLOGY; HEALTH CARE COST; METABOLISM; MULTIMODALITY CANCER THERAPY; SECONDARY PREVENTION; SEVERITY OF ILLNESS INDEX; TRENDS; URINE;

COMBINED MODALITY THERAPY; CONFOUNDING FACTORS (EPIDEMIOLOGY); DIABETIC KETOACIDOSIS; EMERGENCY MEDICAL SERVICES; HEALTH CARE COSTS; HUMANS; KETONE BODIES; KETONES; POINT-OF-CARE TESTING; PREVALENCE; SECONDARY PREVENTION; SEVERITY OF ILLNESS INDEX;

EID: 85014181926     PISSN: 16136071     EISSN: 16140575     Source Type: Journal    
DOI: 10.1900/RDS.2016.13.217     Document Type: Review

References (68)

1. Foster DW, McGarry JD. The metabolic derangements and treatment of diabetic ketoacidosis. N Eng J Med 1983. 309(3):159-169.
2. McGarry JD, Woeltje KF, Kuwajima M, Foster DW. Regulation of ketogenesis and the renaissance of carnitine palmitoyltransferase. Diabetes Metab Rev 1989. 5(3):271-284.
3. Stentz FB, Umpierrez GE, Cuervo R, Kitabchi AE. Proinflammatory cytokines, markers of cardiovascular risks, oxidative stress, and lipid peroxidation in patients with hyperglycemic crises. Diabetes 2004. 53(8):2079-2086.
4. Handelsman Y, Henry RR, Bloomgarden ZT, Dagogo-Jack S, DeFronzo RA, Einhorn D, Ferrannini E, Fonseca VA, Garber AJ, Grunberger G, et al. American Association of Clinical Endocrinologists and American College of Endocrinology position statement on the association of SGLT-2 inhibitors and diabetic ketoacidosis. Endocr Pract 2016. 22(6):753-762.
5. Peters AL, Henry RR, Thakkar P, Tong C, Alba M. Diabetic ketoacidosis with canagliflozin, a sodium-glucose cotransporter 2 inhibitor, in patients with type 1 diabetes. Diabetes Care 2016. 39(4):532-538.
6. Health and Social Care Information Centre. National Diabetes Audit 2012-2013. Report 2: Complications and Mortality. http://www.hscic.gov.uk/catalogue/PUB16496/nati-diabaudi-12-13-rep2.pdf 2015. Accessed 6th September 2016.
7. Karges B, Rosenbauer J, Holterhus PM, Beyer P, Seithe H, Vogel C, Bockmann A, Peters D, Muther S, Neu A, et al. Hospital admission for diabetic ketoacidosis or severe hypoglycemia in 31,330 young patients with type 1 diabetes. Eur J Endocrinol 2015. 173(3):341-350.
8. Craig ME, Jones TW, Silink M, Ping YJ. Diabetes care, glycemic control, and complications in children with type 1 diabetes from Asia and the Western Pacific Region. J Diabetes Complications 2016. 21(5):280-287.
9. Henriksen OM, Roder ME, Prahl JB, Svendsen OL. Diabetic ketoacidosis in Denmark. Diabetes Res Clin Pract 2007. 76(1):51-56.
10. Rosilio M, Cotton JB, Wieliczko MC, Gendrault B, Carel J, Couvaras O, Ser N, Gillet P, Soskin S, Garandeau P, et al. Factors associated with glycemic control:A cross-sectional nationwide study in 2,579 French children with type 1 diabetes. Diabetes Care 1998. 21(7):1146-1153.
11. Faich GA, Fishbein HA, Ellis SE. The epidemiology of diabetic acidosis: a population-based study. Am J Epidemiol 1983. 117(5):551-558.
12. Ginde AA, Pelletier AJ, Camargo CA. National study of U.S. emergency department visits with diabetic ketoacidosis, 1993-2003. Diabetes Care 2006. 29(9):2117-2119.
13. Centers for Disease Control and Prevention. Number (in thousands) of hospital discharges with diabetic ketoacidosis (DKA) as first-listed diagnosis, United States, 1988-2009. http://www.cdc.gov/diabetes/statistics/dkafirst/fig1.htm. 2014. Accessed 6th September 2016.
14. Wang ZH, Kihl-Selstam E, Eriksson JW. Ketoacidosis occurs in both Type 1 and Type 2 diabetes - a populationbased study from Northern Sweden. Diabetic Med 2008. 25(7):867-870.
15. Umpierrez GE, Smiley D, Kitabchi AE. Narrative review:Ketosis-prone type 2 diabetes mellitus. Ann Intern Med 2006. 144(5):350-357.
16. Newton CA, Raskin P. Diabetic ketoacidosis in type 1 and type 2 diabetes mellitus: Clinical and biochemical differences. Arch Intern Med 2004. 164(17):1925-1931.
17. Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN. Hyperglycemic crises in adult patients with diabetes. Diabetes Care 2009. 32(7):1335-1343.
18. Allan J, Howarth S. Diabetes and DKA in England’s primary care trusts. http://dwed.org.uk/s/ DwedReportDKAPCT.pdf. 2010. Accessed 6th September 2016.
19. Byrne ML, Mills LS, Saunders S, Garrett CJ. The economic burden and mortality of recurrent diabetic ketoacidosis:a 3 year cost analysis and mortality follow-up at a district general hospital. Poster 496, 2016. http://onlinelibrary.wiley.com/doi/101111/dme 51_13048/epdf. Accessed 9th February 2017.
20. Mohindru B, Dhatariya KK, Fordham R. Diabetic ketoacidosis in the UK: a cost of illness study based on nationally collected data and use of Joint British Diabetes Societies Inpatient Care Group guidelines. Submitted for publication.
21. Ellemann K, Soerensen JN, Pedersen L, Edsberg B, Andersen OO. Epidemiology and treatment of diabetic ketoacidosis in a community population. Diabetes Care 1984. 7(6):528-532.
22. Bui TP, Werther GA, Cameron FJ. Trends in diabetic ketoacidosis in childhood and adolescence: a 15-yr experience. Pediatr Diabetes 2002. 3(2):82-88.
23. Dunger DB, Sperling MA, Acerini CL, Bohn DJ, Daneman D, Danne TP, Glaser NS, Hanas R, Hintz RL, Levitsky LL, et al. European Society for Paediatric Endocrinology/Lawson Wilkins Pediatric Endocrine Society Consensus Statement on diabetic ketoacidosis in children and adolescents. Pediatrics 2004. 113(2):e133-e140.
24. Rewers A, Dong F, Slover RH, Klingensmith G, Rewers M. Incidence of diabetic ketoacidosis at diagnosis of type 1 diabetes in Colorado youth, 1998-2012. JAMA 2015. 313(15):1570-1572.
25. Usher-Smith JA, Thompson M, Ercole A, Walter FM. Variation between countries in the frequency of diabetic ketoacidosis at first presentation of type 1 diabetes in children: a systematic review. Diabetologia 2012. 55(11):2878-2894.
26. Dhatariya KK, Nunney I, Higgins K, Sampson MJ, Iceton G. A national survey of the management of diabetic ketoacidosis in the UK in 2014. Diabetic Med 2016. 33(2):252-260.
27. Edge JA, Nunney I, Dhatariya KK. Diabetic ketoacidosis in an adolescent and young adult population in the UK in 2014: a national survey comparison of management in paediatric and adult settings. Diabetic Med 2016. 33(10):1352-1359.
28. Basu A, Close CF, Jenkins D, Krentz AJ, Natrass M, Wright AD. Persisting mortality in diabetic ketoacidosis. Diabetic Med 1993. 10(3):282-284.
29. Wright J, Ruck K, Rabbitts R, Charlton M, De P, Barrett T, Baskar V, Kotonya C, Saraf S, Narendran P. Diabetic ketoacidosis (DKA) in Birmingham, UK, 2000-2009: an evaluation of risk factors for recurrence and mortality. Br J Diabetes Vasc Dis 2009. 9(6):278-282.
30. Xu Y, Bai J, Wang G, Zhong S, Su X, Huang Z, Chen G, Zhang J, Hou X, Yu X, et al. Clinical profile of diabetic ketoacidosis in tertiary hospitals in China: a multicentre, clinic-based study. Diabetic Med 2016. 33(2):261-268.
31. Weber C, Kocher S, Neeser K, Joshi SR. Prevention of diabetic ketoacidosis and self-monitoring of ketone bodies:an overview. Curr Med Res Opin 2009. 25(5):1197-1207.
32. Voulgari C, Tentolouris N. The performance of a glucose- ketone meter in the diagnosis of diabetic ketoacidosis in patients with type 2 diabetes in the emergency room. Diabetes Technol Ther 2010. 12(7):529-535.
33. Dhatariya K, Nunney I, Iceton G. Institutional factors in the management of adults with diabetic ketoacidosis in the UK: results of a national survey. Diabetic Med 2016. 33(2):269-270.
34. Noyes KJ, Crofton P, Bath LE, Holmes A, Stark L, Oxley CD, Kelnar CJ. Hydroxybutyrate near-patient testing to evaluate a new end-point for intravenous insulin therapy in the treatment of diabetic ketoacidosis in children. Pediatr Diabetes 2007. 8(3):150-156.
35. Sheikh-Ali M, Karon BS, Basu A, Kudva YC, Muller LA, Xu J, Schwenk WF, Miles JM. Can serum betahydroxybutyrate be used to diagnose diabetic ketoacidosis? Diabetes Care 2008. 31(4):643-647.
36. Rebel A, Rice MA, Fahy BG. The accuracy of point-ofcare glucose measurements. J Diabetes Sci Technol 2012. 6(2):396-411.
37. Ceriotti F, Kaczmarek E, Guerra E, Mastrantonio F, Lucarelli F, Valgimigli F, Mosca A. Comparative performance assessment of point-of-care testing devices for measuring glucose and ketones at the patient bedside. J Diabetes Sci Technol 2015. 9(2):268-277.
38. Byrne HA, Tieszen KL, Hollis S, Dornan TL, New JP. Evaluation of an electrochemical sensor for measuring blood ketones. Diabetes Care 2000. 23(4):500-503.
39. Yu HY, Agus M, Kellogg MD. Clinical utility of Abbott Precision Xceed Pro® ketone meter in diabetic patients. Pediatr Diabetes 2011. 12(7):649-655.
40. Khan AS, Talbot JA, Tieszen KL, Gardener EA, Gibson JM, New JP. Evaluation of a bedside blood ketone sensor: the effects of acidosis, hyperglycaemia and acetoacetate on sensor performance. Diabetic Med 2004. 21(7):782-785.
41. Savage MW, Dhatariya KK, Kilvert A, Rayman G, Rees JA, Courtney CH, Hilton L, Dyer PH, Hamersley MS, for the Joint British Diabetes Societies. Joint British Diabetes Societies guideline for the management of diabetic ketoacidosis. Diabetic Med 2011. 28(5):508-515.
42. Rothera AC. Note on the sodium nitro-prusside reaction for acetone. J Physiol 1908. 37(5-6):491-494.
43. Wallace TM, Matthews DR. Recent advances in the monitoring and management of diabetic ketoacidosis. QJM 2004. 97(12):773-780.
44. Samuelsson U, Ludvigsson J. When should determination of ketonemia be recommended? Diabetes Technol Ther 2002. 4(5):645-650.
45. Laffel L. Sick-day management in type 1 diabetes. Endocrinol Metab Clin North Am 2000. 29(4):707-723.
46. Guerci B, Tubiana-Rufi N, Bauduceau B, Bresson R, Cuperlier A, Delcroix C, Durain D, Fermon C, Le Floch JP, Le Devehat C, et al. Advantages to using capillary blood beta-hydroxybutyrate determination for the detection and treatment of diabetic ketosis. Diabetes Metab 2005. 31(4 Pt 1):401-406.
47. Wallace TM, Meston NM, Gardner SG, Matthews DR. The hospital and home use of a 30-second hand-held blood ketone meter: guidelines for clinical practice. Diabetic Med 2001. 18(8):640-645.
48. Turan S, Omar A, Bereket A. Comparison of capillary blood ketone measurement by electrochemical method and urinary ketone in treatment of diabetic ketosis and ketoacidosis in children. Acta Diabetol 2008. 45(2):83-85.
49. Naunheim R, Jang TJ, Banet G, Richmond A, McGill J. Point-of-care test identifies diabetic ketoacidosis at triage. Acad Emerg Med 2006. 13(6):683-685.
50. Harris S, Ng R, Syed H, Hillson R. Near patient blood ketone measurements and their utility in predicting diabetic ketoacidosis. Diabetic Med 2005. 22(2):221-224.
51. Schwab TM, Hendey GW, Soliz TC. Screening for ketonemia in patients with diabetes. Ann Emerg Med 1999. 34(3):342-346.
52. Taboulet P, Haas L, Porcher R, Manamani J, Fontaine JP, Gautier JF. Urinary acetoacetate or capillary ß-hydroxybutyrate for the diagnosis of ketoacidosis in the Emergency Department setting. Eur J Emerg Med 2004. 11(5):251-258.
53. Charles RA, Bee YM, Eng PH, Goh SY. Point-of-care blood ketone testing: screening for diabetic ketoacidosis at the emergency department. Singapore Med J 2007. 48(11):986-989.
54. Arora S, Menchine M. The role of point-of-care betahydroxybutyrate testing in the diagnosis of diabetic ketoacidosis:A review. Hosp Pract 2012. 40(2):73-78.
55. Arora S, Henderson SO, Long T, Menchine M. Diagnostic accuracy of point-of-care testing for diabetic ketoacidosis at emergency-department triage. Diabetes Care 2011. 34(4):852-854.
56. Scott A, on Behalf of the Joint British Diabetes Societies (JBDS) for Inpatient Care. Management of hyperosmolar hyperglycaemic state in adults with diabetes. Diabetic Med 2015. 32(6):714-724.
57. Wijaya IP, Soewondo P, Widodo D, Sudoyo AW. Beta-hydroxybutyrate levels as a determinant for the success of diabetic ketoacidosis management. Acta Med Indones 2004. 36(2):70-77.
58. Rewers A, McFann K, Chase HP. Bedside monitoring of blood b-hydroxybutyrate levels in the management of diabetic ketoacidosis in children. Diabetes Technol Ther 2006. 8(6):671-676.
59. Ham MR, Okada P, White PC. Bedside ketone determination in diabetic children with hyperglycemia and ketosis in the acute care setting. Pediatr Diabetes 2004. 5(1):39-43.
60. Arora S, Probst MA, Agy C, Menchine M. Point-ofcare beta-hydroxybutyrate testing for assessing diabetic ketoacidosis severity prior to treatment in the emergency department. Diabetes Res Clin Pract 2011. 94(3):e86-e88.
61. Ma OJ, Rush MD, Godfrey MM, Gaddis G. Arterial blood gas results rarely influence emergency physician management of patients with suspected diabetic ketoacidosis. Acad Emerg Med 2003. 10(8):836-841.
62. Herrington WG, Nye HJ, Hammersley MS, Watkinson PJ. Are arterial and venous samples clinically equivalent for the estimation of pH, serum bicarbonate and potassium concentration in critically ill patients? Diabet Med 2012. 29(1):32-35.
63. British Medical Association, Royal Pharmaceutical Society of Great Britain. British National Formulary. 2016.
64. Diabetes UK. Meds and kits. https://shop.diabetes.org.uk/usr/downloads/Meds%20and% 20Kit%20low%20res.pdf. 2016. Accessed 6th September 2016.
65. Klocker AA, Phelan H, Twigg SM, Craig ME. Blood beta-hydroxybutyrate vs. urine acetoacetate testing for the prevention and management of ketoacidosis in type 1 diabetes:a systematic review. Diabet Med 2013. 30(7):818-824.
66. Peters AL, Buschur EO, Buse JB, Cohan P, Diner JC, Hirsch IB. Euglycemic diabetic ketoacidosis: A potential complication of treatment with sodium-glucose cotransporter 2 inhibition. Diabetes Care 2015. 38(9):1687-1693.
67. Evans NR, Richardson L, Dhatariya KK, Sampson MJ. Diabetes specialist nurse telemedicine: admissions avoidance, costs and casemix. Europ Diabetes Nurs 2012. 29(1):17-21.
68. Laffel LM, Wentzell K, Loughlin C, Tovar A, Moltz K, Brink S. Sick day management using blood 3- hydroxybutyrate (3-OHB) compared with urine ketone monitoring reduces hospital visits in young people with T1DM: a randomized clinical trial. Diabet Med 2006. 23(3):278-284.