From the Guidelines
Serum beta-hydroxybutyrate (BHB) is a crucial indicator of ketosis, essential for diagnosing diabetic ketoacidosis (DKA) and monitoring treatment response, with normal levels below 0.6 mmol/L and levels above 3.0 mmol/L suggesting DKA in diabetic patients with hyperglycemia and acidosis. The significance of serum BHB lies in its ability to provide an accurate assessment of ketosis, particularly in emergency settings where rapid diagnosis and treatment of DKA are critical 1. BHB measurement is preferred over urine ketone testing, as it represents about 78% of total ketones in the blood and offers a more precise evaluation of ketosis 1.
Key Points about Serum BHB:
- Normal BHB levels are below 0.6 mmol/L
- Levels above 1.5 mmol/L indicate nutritional ketosis
- Values exceeding 3.0 mmol/L may suggest DKA in diabetic patients with hyperglycemia and acidosis
- BHB measurement is valuable for monitoring therapeutic ketosis in conditions like epilepsy, where ketogenic diets maintain BHB between 2-5 mmol/L 1
- BHB serves as a metabolic fuel and has signaling properties that may influence inflammation and gene expression, contributing to therapeutic benefits in neurological conditions
Clinical Utility of BHB Measurement:
BHB measurement is not only critical for the diagnosis and management of DKA but also for monitoring the effectiveness of treatment, as levels decrease with appropriate insulin therapy and fluid resuscitation 1. Beyond diabetes management, BHB levels are relevant in various clinical contexts, including the use of ketogenic diets for weight control, epilepsy, and other conditions where ketosis has therapeutic benefits 1.
Recommendations for BHB Measurement:
The use of specific BHB measurements is recommended for the diagnosis and monitoring of DKA, rather than methods that rely on the nitroprusside reaction, which may underestimate total ketone body concentration 1. This approach ensures accurate diagnosis and effective management of DKA, highlighting the significance of serum BHB as a critical marker of ketosis in clinical practice.
From the Research
Significance of Serum Beta-Hydroxybutyrate
The significance of serum beta-hydroxybutyrate (BHB) is a crucial aspect of diagnosing and managing diabetic ketoacidosis (DKA) and other metabolic disorders.
- Serum BHB is a key marker for the diagnosis of DKA, as it provides a direct measure of the pathophysiologic derangement in DKA 2.
- The level of serum BHB is significantly higher in patients with DKA compared to those with non-ketotic diabetes and healthy individuals 3, 4.
- Studies have shown that serum BHB has a high diagnostic value for DKA, with an area under the curve of 0.95 and a sensitivity of 76.7% at a cut-off value of 5.3 mmol/L 2.
- Serum BHB can also be used to monitor the severity of DKA and the effectiveness of treatment, as it decreases with treatment 5.
- The measurement of serum BHB is important for individualizing patient education on DKA risk, mitigation, identification, and treatment, particularly in patients with type 1 diabetes treated with sotagliflozin 3.
Clinical Applications
- Serum BHB measurement can be used to diagnose DKA in patients with suspected ketoacidosis, particularly in the emergency department setting 2.
- It can also be used to monitor patients with diabetes who are at risk of developing DKA, such as those with type 1 diabetes or those taking certain medications like sotagliflozin 3.
- The use of serum BHB measurement can help reduce the risk of DKA and improve patient outcomes by enabling early diagnosis and treatment 4.
Laboratory Measurement
- Serum BHB can be measured using an enzyme-rate method, which is a reliable and accurate method for determining serum BHB levels 6.
- The measurement of serum BHB should be performed in conjunction with other laboratory tests, such as blood pH and bicarbonate levels, to provide a comprehensive assessment of the patient's metabolic status 5.