Blood ketone bodies in patients with recent-onset type 1 diabetes (a multicenter study)

Abstract

Blood 3HB evaluation is a better indicator of metabolic control compared to urine KB detection and is useful to predict the time required for blood KB clearing. Further studies are needed to assess its use in the early detection and management of DKA.

ISPAD Clinical Practice Consensus Guidelines 2018: Diabetic ketoacidosis and the hyperglycemic hyperosmolar state

“…Acute management should follow the general guidelines for PALS, with particular attention to the following: Immediately measure blood glucose and blood BOHB concentrations with bedside meters or with urine test strips that measure only acetoacetic acid if bedside blood ketone measurements are not available. Perform a clinical evaluation to identify a possible infection. Measurement of blood BOHB concentration with a point‐of‐care meter, if available, is useful to confirm ketoacidosis (≥3 mmol/L in children) and to monitor the response to treatment Weigh the patient.…”

“…There should be documentation on a flow chart of hour‐by‐hour clinical observations, IV and oral medications, fluids, and laboratory results. Monitoring should include the following: Hourly (or more frequently as indicated) vital signs (heart rate, respiratory rate, blood pressure) Hourly (or more frequently as indicated) neurological observations (Glasgow coma score; Table ) for warning signs and symptoms of cerebral edema (see below) onset of headache after starting DKA treatment or worsening of headache already present before commencing treatment inappropriate slowing of heart rate recurrence of vomiting change in neurological status (restlessness, irritability, increased drowsiness, confusion, incontinence) or specific neurologic signs (eg, cranial nerve palsies, abnormal pupillary responses) rising blood pressure decreased oxygen saturation rapidly increasing serum sodium concentration suggesting loss of urinary free water as a manifestation of diabetes insipidus (from interruption of blood flow to the pituitary gland due to cerebral herniation) Amount of administered insulin Hourly (or more frequently as indicated) accurate fluid input (including all oral fluid) and output . Capillary blood glucose concentration should be measured hourly (but must be cross‐checked against laboratory venous glucose as capillary methods may be inaccurate in the presence of poor peripheral circulation and acidosis, and is limited in measuring extremely high levels). Laboratory tests : serum electrolytes, glucose, blood urea nitrogen, calcium, magnesium, phosphate, hematocrit, and blood gases should be repeated 2 to 4 hourly, or more frequently, as clinically indicated, in more severe cases. Blood BOHB concentrations, if available, every 2 to 4 hours Near‐patient (also referred to as point‐of‐care) BOHB measurements correlate well with a reference method up to 3 mmol/L, but are not accurate above 5 mmol/L …”

“…Blood BOHB concentrations, if available, every 2 to 4 hours Near‐patient (also referred to as point‐of‐care) BOHB measurements correlate well with a reference method up to 3 mmol/L, but are not accurate above 5 mmol/L …”

Diabetic ketoacidosis and hyperglycemic hyperosmolar state

“…Perform a clinical evaluation to identify a possible infection. ○Measurement of blood BOHB concentration with a point‐of‐care meter, if available, is useful to confirm ketoacidosis (≥3 mmol/L in children) and to monitor the response to treatment . Weigh the patient. If body surface area is used for fluid therapy calculations, measure height or length to determine surface area.…”

Integration of enzyme immobilised single-walled carbon nanotube arrays into microfluidic devices for glucose detection

“…The early sensors tested for ketones in urine, which are indicative of raised blood glucose levels [1]. However the delay in metabolism of glucose to ketone metabolites prevented close monitoring of blood glucose.…”