Urine versus blood ketones

Brewster, Sarah; Curtis, Louise; Poole, Ruth

doi:10.1002/pdi.2070

Cited by 7 publications

(10 citation statements)

References 8 publications

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“…Urine dipsticks have been in clinical use for more than 50 years, initially to detect life-threating ketoacidosis in individuals with diabetes. 17 In contrast, blood monitors detect the concentration of β-hydroxybutyrate in blood, typically capillary blood from a finger prick. Blood monitors have overcome some of the limitations of urine dipsticks, most notably that urine dipsticks only provide a surrogate marker of the more clinically relevant β-hydroxybutyrate, as well as the difficulty of obtaining a urine sample from an unconscious patient.…”

Section: Introductionmentioning

confidence: 99%

“…Compared to blood monitors, urine dipsticks are equally able to identify 'true positive' cases of ketoacidosis in people with diabetes (high sensitivity), albeit they have a lower ability to identify 'true negatives' among people with diabetic ketoacidosis (lower specificity). [17][18][19][20] As well as being less invasive than blood ketone monitors (some people may be averse to pricking their finger), urine dipsticks are at least seven times cheaper than blood monitors, at around US$0.10 per dipstick compared with around US $0.70 per test trip for the blood monitors. Furthermore, the blood ketone monitor itself typically costs at least another US$25.00.…”

Section: Introductionmentioning

confidence: 99%

“…Urine dipsticks detect the presence of acetoacetate in urine by a colorimetric reaction with nitroprusside. Urine dipsticks have been in clinical use for more than 50 years, initially to detect life‐threating ketoacidosis in individuals with diabetes 17 . In contrast, blood monitors detect the concentration of β‐hydroxybutyrate in blood, typically capillary blood from a finger prick.…”

Section: Introductionmentioning

confidence: 99%

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Urine dipsticks are not accurate for detecting mild ketosis during a severely energy restricted diet

Gibson

Eroğlu

Rooney

et al. 2020

Obesity Science & Practice

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Background: Detection of the mild ketosis induced by severely energy-restricted diets may be a clinically useful way to monitor and promote dietary adherence. Mild ketosis is often assessed using urine dipsticks, but accuracy for this purpose has not been tested. Objective: To determine the accuracy of urine dipsticks to detect mild ketosis during adherence to a severely energy-restricted diet. Methods: Two hundred and sixty three (263) fasting urine and 263 fasting blood samples were taken from 50 women (mean [standard deviation, SD] age 58.0 [4.3] years and body mass index 34.3 [2.4] kg/m 2) before and at six time points during or for up to 10 weeks after 16 weeks of severe energy restriction, achieved with a total meal replacement diet. The amount of ketones (acetoacetate) in the urine was classified as '0 (Negative)', '+/− (Trace)', '+ (Weak)' or '++ (Medium)' by urine dipsticks (Ketostix, Bayer). The concentration of ketones (β-hydroxybutyrate) in the blood was measured with our reference method, a portable ketone monitor (FreeStyle Optium, Abbott). The diagnostic accuracy of the urine dipsticks was assessed from the percent of instances when a person was actually 'in ketosis' (as defined by a blood β-hydroxybutyrate concentration at or above three different thresholds) that were also identified by the urine dipsticks as being from a person in ketosis (the percent 'true positives' or sensitivity), as well as the percent of instances when a person was not in ketosis (as defined by the blood monitor result) was correctly identified as such with the urine dipstick (the percent 'true negatives' or specificity). Thresholds of ≥0.3mM, ≥0.5mM or ≥1.0mM were selected, because mean blood concentrations of β-hydroxybutyrate during ketogenic diets are approximately 0.5mM. Sensitivity and specificity were then used to generate receiver operating characteristic curves, with the area under these curves indicating the ability of the dipsticks to correctly identify people in ketosis (1 = perfect results, 0.5 = random results). Radhika V Seimon and Amanda Sainsbury contributed equally to this work.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Urine dipsticks are not accurate for detecting mild ketosis during a severely energy restricted diet

Gibson

Eroğlu

Rooney

et al. 2020

Obesity Science & Practice

View full text Add to dashboard Cite

show abstract

“…Thus, it is desirable to be able to consistently identify low urinary concentrations of acetoacetic acid in order to detect early DKA. While diagnostic criteria for DKA include ketone concentrations greater than 17 mg/dL, concentrations above 3.5 mg/dL indicate abnormal levels of ketone production [22].…”

Section: B Ketone Dose-response Characterizationmentioning

confidence: 99%

“…Whereas dipsticks are designed to be read by visual analysis, automated analyzers have been shown to reduce variation and error in test results [19]- [21]. When considering the further comorbidity between diabetes and visual impairment, visual analysis increases the likelihood of improper test interpretation [22], [23]. Semi-quantitative reflectance photometry has thus been maintained as the gold standard for automated POC urinalysis, with multi wavelength measurement devices becoming more common [21], [24], [25].…”

Section: Introductionmentioning

confidence: 99%

Analysis of Paper-Based Colorimetric Assays With a Smartphone Spectrometer

2019

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We report on the adaptation of a smartphone's rear-facing camera to function as a spectrometer that measures the spectrum of light scattered by common paper-based assay test strips. We utilize a cartridge that enables a linear series of test pads in a single strip to be swiped past the read head of the instrument while the phone's camera records video. The strip is housed in a customfabricated cartridge that slides through the instrument to facilitate illumination with white light from the smartphone's flash LED that is directed through an optical fiber. We demonstrate the ability to detect subtle changes in the scattered spectrum that enables quantitative analysis of single-analyte and multi-analyte strips. The demonstrated capability can be applied to broad classes of paper-based assays in which visual observation of colored strips is not sufficiently quantitative, and for which analysis of red-green-blue pixel values of a camera image are not capable of measuring complex scattered spectra.

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How should acid-base disorders be diagnosed?

Neligan¹

2020

Evidence-Based Practice of Critical Care

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Urine versus blood ketones

Cited by 7 publications

References 8 publications

Urine dipsticks are not accurate for detecting mild ketosis during a severely energy restricted diet

Urine dipsticks are not accurate for detecting mild ketosis during a severely energy restricted diet

Analysis of Paper-Based Colorimetric Assays With a Smartphone Spectrometer

How should acid-base disorders be diagnosed?

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