The effectiveness of blood glucose and blood ketone measurement in identifying significant acidosis in diabetic ketoacidosis patients

Diabetology & Metabolic Syndrome

Research

Eric S. Kilpatrick¹  Naji Alamuddin²  Sawsan Saeed³  Alexandra E. Butler³  Stephen L. Atkin³  David B. Sacks⁴ 

[1] Department of Clinical Biochemistry, Sidra Medicine, Doha, Qatar;Department of Medicine, Royal College of Surgeons in Ireland, PO Box 15503, Busaiteen, Adliya, Bahrain;Department of Internal Medicine, King Hamad University Hospital, Busaiteen, Adliya, Bahrain;Department of Postgraduate Studies and Research, Royal College of Surgeons in Ireland, PO Box 15503, Busaiteen, Adliya, Bahrain;National Institutes of Health, Bethesda, MD, USA;

关键词: Diabetic ketoacidosis;    beta-hydroxybutyrate;    Ketones;    Bicarbonate;    Acid-base status;    pH;   

DOI  :  10.1186/s13098-023-01176-w

 received in 2023-07-03, accepted in 2023-09-30,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundPatients with diabetic ketoacidosis (DKA), a potentially fatal complication of type 1 diabetes, have hyperglycemia, ketonemia and metabolic acidosis. Blood glucose and blood ketone results are often used to triage patients with suspected DKA. This study aimed to establish how effective blood glucose and blood ketone (beta-hydroxybutyrate, BOHB) measurements are in identifying patients with significant acidosis and sought to validate existing diagnostic BOHB thresholds.MethodsInitial Emergency Department results on 161 presumptive DKA episodes in 95 patients (42 F, 53 M, age range 14–89 years) containing a complete dataset of D (glucose), K (BOHB) and A (Bicarbonate [HCO3] and pH) results.ResultsBlood glucose correlated poorly with BOHB (r = 0.28 p = 0.0003), pH (r= -0.25, p = 0.002) and HCO3 (r= -0.17, p = 0.04). BOHB, though better, was still limited in predicting pH (r = -0.44, p < 0.0001) and HCO3 (r = -0.49, p < 0.0001). A HCO3 of 18mmol/L equated to a BOHB concentration of 4.3mmol/L, whilst a HCO3 of 15mmol/L equated to a BOHB of 4.7mmol/L. Of the 133 of 161 events with HCO3 < 18mmol/L, 22 were not hyperglycemic (> 13.9mmol/L, n = 8), ketonemic (≤ 3mmol/L, n = 9) or either (n = 5).ConclusionsThe commonly employed BOHB diagnostic cutoff of 3mmol/L could not be verified. Since acid-base status was poorly predicted by both glucose and BOHB, this highlights that, regardless of their results, pH and/or HCO3 should also be tested in any patient suspected of DKA.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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