From the Research
Beta-hydroxybutyrate (BHB) levels of 3.0 mmol/L or higher are typically used to diagnose diabetic ketoacidosis (DKA). While traditional DKA diagnosis relies on a triad of hyperglycemia (blood glucose >250 mg/dL), metabolic acidosis (pH <7.3 or bicarbonate <18 mEq/L), and ketosis, BHB measurement provides a more specific and sensitive assessment of ketone production. BHB represents 75% of ketones in DKA and is the predominant ketone body, making it more reliable than urine ketone testing which only detects acetoacetate.
Key Points to Consider
- Point-of-care BHB testing allows for rapid diagnosis, with levels between 1.0-3.0 mmol/L suggesting ketosis, while levels above 3.0 mmol/L are consistent with DKA, as supported by a study published in 1.
- Serial BHB measurements can also help monitor treatment response, with decreasing levels indicating resolution of ketosis.
- For patients with euglycemic DKA (normal blood glucose but elevated ketones), which can occur with SGLT2 inhibitor use or during pregnancy, BHB testing is particularly valuable as these cases might be missed by glucose screening alone.
Recent Guidelines and Recommendations
- A recent review published in 2 highlights the importance of prompt diagnosis and treatment of DKA, and the role of BHB measurement in this process.
- The study published in 3 also supports the use of BHB measurement for monitoring DKA, and suggests that it may be a more reliable indicator of ketosis than urine ketone testing.
Clinical Implications
- BHB levels should be used in conjunction with clinical judgment and other diagnostic criteria to diagnose DKA, as emphasized in 4.
- The use of BHB measurement can help improve patient outcomes by allowing for earlier diagnosis and treatment of DKA, and by reducing the risk of complications associated with delayed or inadequate treatment.