What is the significance of beta-hydroxybutyrate (BHB)?

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Dainyal Siddiqui, MD

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Manuel Jimenez, MD

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Franz Pierre-Louis, MD

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Last updated: April 17, 2025 • View editorial policy

From the Guidelines

Beta-hydroxybutyrate (bOHB) should be specifically measured in blood for the diagnosis of diabetic ketoacidosis (DKA) and may be used for monitoring during treatment of DKA. This is based on the most recent guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus, as outlined in a 2023 study published in Diabetes Care 1. The study recommends using specific measurement of b-hydroxybutyrate in blood for DKA diagnosis and monitoring, with a moderate level of evidence.

  • Key points to consider when measuring bOHB include:
    • The use of blood ketone determinations that rely on the nitroprusside reaction should be avoided for monitoring treatment of DKA, due to the low level of evidence supporting their use 1.
    • The measurement of bOHB can provide valuable information for the diagnosis and management of DKA, and should be used in conjunction with other clinical and laboratory findings.
    • Healthcare providers should be aware of the potential benefits and limitations of measuring bOHB in clinical practice, and should consult relevant guidelines and recommendations when making decisions about patient care.
  • In terms of the clinical significance of bOHB measurement, it is essential to consider the potential impact on patient outcomes, including morbidity, mortality, and quality of life.
    • The use of specific bOHB measurement can help to improve the accuracy of DKA diagnosis and monitoring, which can in turn reduce the risk of complications and improve patient outcomes 1.
    • However, the measurement of bOHB should be used in conjunction with other clinical and laboratory findings, and should not be relied upon as the sole diagnostic or monitoring tool.

From the Research

Beta Hydroxybutyrate Overview

  • Beta hydroxybutyrate (BHB) is a ketone body that can be used to diagnose and manage diabetic ketoacidosis (DKA) 2, 3, 4
  • BHB levels can be measured in capillary blood, serum, or plasma, and can provide a more accurate diagnosis of DKA than traditional methods such as urine ketone testing or blood pH and bicarbonate levels 3, 5, 4

Diagnostic Thresholds

  • A BHB level of 0.5 mmol/L or higher may indicate the need for therapeutic management in diabetic patients with hyperglycemia 2
  • A BHB level of 3.0 mmol/L or higher may be used to diagnose DKA in children, while a level of 3.8 mmol/L or higher may be used in adults 3
  • A BHB level of 5.3 mmol/L may be used to predict DKA with optimal accuracy in pediatric patients 4

Clinical Applications

  • BHB testing may be more effective than urine ketone testing in reducing emergency department assessments, hospitalizations, and time to recovery from DKA, as well as potentially lowering healthcare expenditure 5
  • Ketogenic diets, which produce BHB as a primary source of energy, may have therapeutic benefits in the prevention and treatment of diabetic kidney disease (DKD) by improving glucose and lipid metabolism, regulating autophagy, and alleviating inflammation and oxidative stress 6

Measurement and Testing

  • Capillary blood BHB testing may be a convenient and rapid method for diagnosing and managing DKA, especially in emergency situations 2, 5
  • Plasma or serum BHB testing may provide a more accurate diagnosis of DKA than capillary blood testing, and may be used to monitor treatment response and adjust management decisions 3, 4

References

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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