From the Guidelines
Monitoring serum beta-hydroxybutyrate levels is more accurate than urine acetoacetate levels for detecting diabetic ketoacidosis (DKA) in adolescent patients with Type 1 diabetes mellitus. Blood beta-hydroxybutyrate testing provides real-time ketone measurements with greater sensitivity and specificity, allowing for earlier detection of developing ketosis, as noted in the most recent guidelines 1. The recommended approach is supported by the fact that beta-hydroxybutyrate is the strongest and most prevalent acid in DKA, and its measurement is not affected by the limitations of urine ketone testing, such as delayed results and interference from hydration status and medication use 1.
Key points to consider in the management and detection of DKA include:
- The importance of measuring beta-hydroxybutyrate levels for accurate assessment of ketosis, as it is the predominant ketone body in DKA 1
- The limitations of urine ketone testing, including its inability to measure beta-hydroxybutyrate and potential for delayed or misleading results 1
- The availability and utility of blood ketone meters for home use, which can provide immediate results and facilitate timely intervention 1
- The need for education on "sick day rules" for ketosis-prone individuals, including oral hydration, additional insulin, and frequent monitoring of blood glucose and ketones 1
In clinical practice, the use of serum beta-hydroxybutyrate levels as the primary method for detecting DKA is recommended, given its superiority over urine acetoacetate testing in terms of accuracy and reliability, as supported by the most recent and highest quality evidence 1.
From the Research
Comparison of Urine Acetoacetate and Serum Beta-Hydroxybutyrate Levels
- Monitoring serum beta-hydroxybutyrate levels is more accurate than urine acetoacetate levels in detecting diabetic ketoacidosis (DKA) in adolescent patients with Type 1 Diabetes Mellitus (T1DM) 2, 3, 4, 5, 6.
- Serum beta-hydroxybutyrate testing has been shown to be more effective than urine acetoacetate testing in reducing emergency department assessment, hospitalization, and time to recovery from DKA, as well as potentially lowering healthcare expenditure 2.
- A study found that blood ketone testing compared with urine testing was associated with reduced frequency of hospitalization, reduced time to recovery from DKA, cost benefits, and greater satisfaction 2.
- Plasma beta-hydroxybutyrate has been found to accurately predict DKA in children and adolescents, with a cut-point value of 5.3 mmol/L predicting DKA with optimal accuracy 3.
- Bedside monitoring of blood beta-hydroxybutyrate levels has been found to simplify management of DKA by eliminating superfluous laboratory monitoring, with good agreement between bedside meter beta-hydroxybutyrate levels and reference laboratory method 5.
- A plasma beta-hydroxybutyrate value of <1.5 mmol/L has been found to define resolution of DKA, with a sensitivity of 83% and specificity of 87% 6.