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Beta Hydroxybutyrate Dka

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Initial Evaluation Initial evaluation of patients with DKA includes diagnosis and treatment of precipitating factors (Table 14–18). The most common precipitating factor is infection, followed by noncompliance with insulin therapy.3 While insulin pump therapy has been implicated as a risk factor for DKA in the past, most recent studies show that with proper education and practice using the pump, the frequency of DKA is the same for patients on pump and injection therapy.19 Common causes by frequency Other causes Selected drugs that may contribute to diabetic ketoacidosis Infection, particularly pneumonia, urinary tract infection, and sepsis4 Inadequate insulin treatment or noncompliance4 New-onset diabetes4 Cardiovascular disease, particularly myocardial infarction5 Acanthosis nigricans6 Acromegaly7 Arterial thrombosis, including mesenteric and iliac5 Cerebrovascular accident5 Hemochromatosis8 Hyperthyroidism9 Pancreatitis10 Pregnancy11 Atypical antipsychotic agents12 Corticosteroids13 FK50614 Glucagon15 Interferon16 Sympathomimetic agents including albuterol (Ventolin), dopamine (Intropin), dobutamine (Dobutrex), terbutaline (Bricanyl),17 and ritodrine (Yutopar)18 DIFFERENTIAL DIAGNOSIS Three key features of diabetic acidosis are hyperglycemia, ketosis, and acidosis. The conditions that cause these metabolic abnormalities overlap. The primary differential diagnosis for hyperglycemia is hyperosmolar hyperglycemic state (Table 23,20), which is discussed in the Stoner article21 on page 1723 of this issue. Common problems that produce ketosis include alcoholism and starvation. Metabolic states in which acidosis is predominant include lactic acidosis and ingestion of drugs such as salicylates and methanol. Abdominal pain may be a symptom of ketoacidosis or part of the inci Continue reading >>

Lab Test

Lab Test

Measurement of beta-hydroxybutyrate in whole blood, serum, or plasma to evaluate ketone-producing metabolic energy deficits that usually occur when there is insufficient carbohydrate metabolism, thereby increasing the catabolism of fatty acids. Clinical Application Common tests for ketone bodies, such as Acetest, Chemstrip, and Ketostix, do not detect beta-hydroxybutyrate. A handheld meter sensor system is available to monitor beta-hydroxybutyrate and glucose levels. Elevated levels beta-hydroxybutyrate is diagnostic of ketoacidosis, whereas the absence of concomitant hyperglycemia supports the diagnosis of alcoholic ketoacidosis (AKA). Levels ³ 3 mmol/L are indicative of ketoacidosis. In very severe diabetic ketoacidosis (DKA), the beta-hydroxybutyrate serum concentration may exceed 25 mmol/L. Patients presenting with isopropanol intoxication can present with high acetone levels without any acidosis, anion gap or abnormal glucoses levels. Plasma (lithium-heparin or fluoride-oxalate), serum, or perchloric acid (PCA) extracts can be analyzed. EDTA-plasma samples will produce values that are 60% lower than specimens preserved with fluoride-oxalate or PCA. Continue reading >>

What Is Betahydroxybutyrate Or Bhb?

What Is Betahydroxybutyrate Or Bhb?

[et_pb_section bb_built=”1″ admin_label=”section” padding_mobile=”off” _builder_version=”3.0.47″ custom_padding_tablet=”50px|0|50px|0″ custom_padding_last_edited=”on|desktop”][et_pb_row admin_label=”row” padding_mobile=”off” column_padding_mobile=”on” _builder_version=”3.0.47″ background_size=”initial” background_position=”top_left” background_repeat=”repeat”][et_pb_column type=”4_4″][et_pb_text _builder_version=”3.0.89″ background_size=”initial” background_position=”top_left” background_repeat=”repeat”] Beta…hydro…what? Technical and “science-y” words can be super intimidating, but we’re here to break down one of the top words in the ketogenic diet community — betahydroxybutryate (or BHB). We’ll chat all about what BHB is, why you’d want to use it for energy, and all about side effects and benefits. Beta-hydroxybutyrate, or simply BHB, is a molecule that is considered a ketone body. It is one of the main molecules that helps your body produce energy in the absence of glucose. This molecule is essential if you using your own fat for fuel, or taking BHB as a supplement to increase energy production — essentially to be in nutritional ketosis. If you’re not certain about what ketones are or what nutritional ketosis is, you should back up a little bit and read more about that here. Technically speaking, beta-hydroxybutyrate is NOT a ketone body. Ketone bodies, or ketones are technically carbonyl carbons who are bonded to two additional carbons atoms. One carbon has four available bonds, double bonded to oxygen and two single bonds to carbon, we have a ketone. If you have a carbon atom that is double bonded to an oxygen (carbonyl group), which is also bound to an -OH group instead of Continue reading >>

Role Of Measurement Of Blood Ketone Bodies In The Management Of Diabetic Ketoacidosis

Role Of Measurement Of Blood Ketone Bodies In The Management Of Diabetic Ketoacidosis

Objective: The present study was designed to investigate whether early detection of blood ketone bodies help in diagnosing Diabetic ketoacidosis (DKA) and also to explore whether early changes in blood β-hydroxybutyrate is associated with serum electrolytes and acid-base abnormalities. Research Design and Methods: A total of 122 consecutive type 2 diabetic patients (age 39 ± 15 yrs and body mass index 20.3 ± 2.4 kg/m 2 , mean ± SD) were included in the study. Plasma glucose was measured by glucose oxidase method, glycosylated haemoglobin (HbA 1C ) by high-performance liquid chromatography method, blood β-hydroxybutyrate by biosensor method; urinary acetone was measured by strip based on nitroprusside reaction. Serum urea and creatinine were measured by enzymatic method. Serum electrolytes were measured by ion sensitive electrode technique. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for urinary ketone method were calculated against the blood ketone. Results: The relative frequencies of DKA, using urinary ketone and blood ketone criteria, were 15.6% (19 out of 122) and 13.9% (17 out of 122), respectively. In contrast, 50% (61 out of 122) patients showed hyperketonemia. Using blood ketone as the reference method, the sensitivity of urinary ketone measurement was found to be 32.6% and specificity was 93.7%. PPV and NPV of urinary ketone against blood ketone were 73.68% and 71.84%, respectively. The DKA subjects, diagnosed by blood ketone criteria, showed significant biochemical derangements as compared to Non-DKA subjects [serum urea (P < 0.001), creatinine (P = 0.02), sodium (P < 0.001), potassium (P < 0.001), total carbon dioxide (P = 0.02), and osmolality (P = 0.02)]. Correlation analysis shows that electrolytes, b Continue reading >>

Blood Ketones

Blood Ketones

On This Site Tests: Urine Ketones (see Urinalysis - The Chemical Exam); Blood Gases; Glucose Tests Elsewhere On The Web Ask a Laboratory Scientist Your questions will be answered by a laboratory scientist as part of a voluntary service provided by one of our partners, the American Society for Clinical Laboratory Science (ASCLS). Click on the Contact a Scientist button below to be re-directed to the ASCLS site to complete a request form. If your question relates to this web site and not to a specific lab test, please submit it via our Contact Us page instead. Thank you. Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Related conditions: Type 1 diabetes, type 2 diabetes, Insulin-dependent diabetes, childhood diabetes , hyperglycemic coma, hyperosmolar coma, septicemia Diabetic ketoacidosis (DKA) is a serious and potentially life-threatening complication of diabetes mellitus, usually type 1 insulin-dependent diabetes. It can occasionally be seen in patients with type 2 diabetes in the presence of stress, trauma or infection. It is characterized by hyperglycemia, elevated blood ketones with metabolic acidosis and dehydration with body water and electrolyte depletion. DKA may occur from infancy to late adulthood. Important differences exist in management due to the almost exclusive complication of cerebral edema in children and adolescents. Polydipsia, polyuria and weight loss are the predominant presenting symptoms. Weight loss is not only due to loss of body water via diuresis or vomiting but may be accelerated by poor appetite and starvation. Nocturia is a common feature in childhood DKA. Other nonspecific symptoms include fever, fatigue, nausea, vomiting and abdominal pain. These may not always be related to a primary precipitating event (e.g. urinary tract infection, pancreatitis). In adults infection is the most common precipitating event. Coexisting medical and surgical problems are more likely in adult patients. In contrast, acute DKA is the primary presentation of childhood diabetes in about 20% of cases. Noncompliance with insulin therapy is common in patients with recurrent admissions. Dehydration occurs over days to weeks following the glucose-driven osmotic diuresis. Clinical estimation of degree of dehydration is poor, and there is frequently a poor correlation between markers of dehydration and shock and degree of hyperglycemia / acidosis. There is an increased risk of t Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Related conditions: Type 1 diabetes, type 2 diabetes, Insulin-dependent diabetes, childhood diabetes , hyperglycemic coma, hyperosmolar coma, septicemia Diabetic ketoacidosis (DKA) is a serious and potentially life-threatening complication of diabetes mellitus, usually type 1 insulin-dependent diabetes. It can occasionally be seen in patients with type 2 diabetes in the presence of stress, trauma or infection. It is characterized by hyperglycemia, elevated blood ketones with metabolic acidosis and dehydration with body water and electrolyte depletion. DKA may occur from infancy to late adulthood. Important differences exist in management due to the almost exclusive complication of cerebral edema in children and adolescents. Polydipsia, polyuria and weight loss are the predominant presenting symptoms. Weight loss is not only due to loss of body water via diuresis or vomiting but may be accelerated by poor appetite and starvation. Nocturia is a common feature in childhood DKA. Other nonspecific symptoms include fever, fatigue, nausea, vomiting and abdominal pain. These may not always be related to a primary precipitating event (e.g. urinary tract infection, pancreatitis). In adults infection is the most common precipitating event. Coexisting medical and surgical problems are more likely in adult patients. In contrast, acute DKA is the primary presentation of childhood diabetes in about 20% of cases. Noncompliance with insulin therapy is common in patients with recurrent admissions. Dehydration occurs over days to weeks following the glucose-driven osmotic diuresis. Clinical estimation of degree of dehydration is poor, and there is frequently a poor correlation between markers of dehydration and shock and degree of hyperglycemia / acidosis. There is an increased risk of t Continue reading >>

Beta-hydroxybutyric Acid

Beta-hydroxybutyric Acid

Not to be confused with -Hydroxy -methylbutyric acid . -Hydroxybutyric acid, also known as 3-hydroxybutyric acid, is an organic compound and a beta hydroxy acid with the chemical formula CH3CH(OH)CH2CO2H; its conjugate base is -hydroxybutyrate, also known as 3-hydroxybutyrate. -Hydroxybutyric acid is a chiral compound with two enantiomers : --hydroxybutyric acid. Its oxidized and polymeric derivatives occur widely in nature. --hydroxybutyrate can be synthesized in the liver via the metabolism of fatty acids (e.g., butyrate ), -hydroxy -methylbutyrate , and ketogenic amino acids through a series of reactions that metabolize these compounds into acetoacetate , which is the first ketone body that is produced in the fasting state. The biosynthesis of --hydroxybutyrate from acetoacetate is catalyzed by the -hydroxybutyrate dehydrogenase enzyme . --hydroxybutyrate via a second metabolic pathway that does not involve acetoacetate as a metabolic intermediate. This metabolic pathway is as follows: [1] The last reaction in this metabolic pathway, which involves the conversion of --hydroxybutyrate, is catalyzed by the hydroxybutyrate-dimer hydrolase enzyme. [1] The concentration of -hydroxybutyrate in human blood plasma, as with other ketone bodies , increases through ketosis . [2] This elevated -hydroxybutyrate level is naturally expected, as -hydroxybutyrate is formed from acetoacetate. The compound can be used as an energy source by the brain when blood glucose is low. [3] Diabetic patients can have their ketone levels tested via urine or blood to indicate diabetic ketoacidosis . In alcoholic ketoacidosis , this ketone body is produced in greatest concentration. Ketogenesis occurs if oxaloacetate in the liver cells is depleted, a circumstance created by reduced carbohydrate in Continue reading >>

Evaluation Of Capillary Beta-hydroxybutyrate Measurement In Diabetic Ketoacidosis By: Hesham El Hefnawy By:el Hefnawy, H.*; Bassyouni, A.** And Emara, I.*** From: *pediatric, **internal Medicine And ***biochemistry Departments, National Institute Of Diabetes [amp] Endocrinology (nide)

Evaluation Of Capillary Beta-hydroxybutyrate Measurement In Diabetic Ketoacidosis By: Hesham El Hefnawy By:el Hefnawy, H.*; Bassyouni, A.** And Emara, I.*** From: *pediatric, **internal Medicine And ***biochemistry Departments, National Institute Of Diabetes [amp] Endocrinology (nide)

Evaluation of capillary Beta-hydroxybutyrate measurement In diabetic ketoacidosis By: Hesham El Hefnawy By:El Hefnawy, H.*; Bassyouni, A.** and Emara, I.*** From: *Pediatric, **Internal Medicine and ***Biochemistry departments, National Institute of Diabetes [amp] Endocrinology (NIDE) Background: Current criteria for the diagnosis of diabetic ketoacidosis (DKA) are limited by their nonspecificity (serum bicarbonate [HCO3] and pH) and qualitative nature (the presence of ketonemia/ketonuria). A new method is now available to measure capillary levels of beta-hydroxybutyrate (beta -0HB), It is a quantitative and enzymatic test that uses the same equipment as for home capillary blood glucose determination but with specific strips. Aim of the work: The aim of this study was to evaluate the use of measurement of capillary B-hydroxybutyrate (beta-OHB) during the diagnosis and follow up of type 1 diabetic patients with DKA. Subjects and Methods: This study was conducted on 40 type 1 diabetic patients presented to (NIDE) with DKA and who were aged 420 years and half of them was males. 140 capillary blood samples were tested for beta-hydroxybutyrate using blood beta-OHB test strips. Measurement of serum bicarbonatre (HCO3), blood glucose and urine acetone and estimation of venous blood pH and anion gap had been done for all patients. Results: Linear regression revealed highly significant correlation between capillary -OHB levels and all indices of acidosis but no significant correlation between acetone in urine and serum bicarbonate. Using regression to predict values of HCO3, pH and anion gap from -OHB levels revealed that levels of -OHB of 1.4, 1.9, 2.7,3.5 and 4.0 mmol/l corresponded to HCO3 levels of >18, 1518, 10-<15, 5-<10 mEq/l. Conclusions: The measurement of capillary -O Continue reading >>

Can Serum Β-hydroxybutyrate Be Used To Diagnose Diabetic Ketoacidosis?

Can Serum Β-hydroxybutyrate Be Used To Diagnose Diabetic Ketoacidosis?

Abstract OBJECTIVE—Current criteria for the diagnosis of diabetic ketoacidosis (DKA) are limited by their nonspecificity (serum bicarbonate [HCO3] and pH) and qualitative nature (the presence of ketonemia/ketonuria). The present study was undertaken to determine whether quantitative measurement of a ketone body anion could be used to diagnose DKA. RESEARCH DESIGN AND METHODS—A retrospective review of records from hospitalized diabetic patients was undertaken to determine the concentration of serum β-hydroxybutyrate (βOHB) that corresponds to a HCO3 level of 18 mEq/l, the threshold value for diagnosis in recently published consensus criteria. Simultaneous admission βOHB and HCO3 values were recorded from 466 encounters, 129 in children and 337 in adults. RESULTS—A HCO3 level of 18 mEq/l corresponded with βOHB levels of 3.0 and 3.8 mmol/l in children and adults, respectively. With the use of these threshold βOHB values to define DKA, there was substantial discordance (∼≥20%) between βOHB and conventional diagnostic criteria using HCO3, pH, and glucose. In patients with DKA, there was no correlation between HCO3 and glucose levels on admission and a significant but weak correlation between βOHB and glucose levels (P < 0.001). CONCLUSIONS—Where available, serum βOHB levels ≥3.0 and ≥3.8 mmol/l in children and adults, respectively, in the presence of uncontrolled diabetes can be used to diagnose DKA and may be superior to the serum HCO3 level for that purpose. The marked variability in the relationship between βOHB and HCO3 is probably due to the presence of other acid-base disturbances, especially hyperchloremic, nonanion gap acidosis. Recently published consensus criteria for diagnosing diabetic ketoacidosis (DKA) include a serum bicarbonate (HCO3) Continue reading >>

Ketoacidosis

Ketoacidosis

GENERAL ketoacidosis is a high anion gap metabolic acidosis due to an excessive blood concentration of ketone bodies (keto-anions). ketone bodies (acetoacetate, beta-hydroxybutyrate, acetone) are released into the blood from the liver when hepatic lipid metabolism has changed to a state of increased ketogenesis. a relative or absolute insulin deficiency is present in all cases. CAUSES The three major types of ketosis are: (i) Starvation ketosis (ii) Alcoholic ketoacidosis (iii) Diabetic ketoacidosis STARVATION KETOSIS when hepatic glycogen stores are exhausted (eg after 12-24 hours of total fasting), the liver produces ketones to provide an energy substrate for peripheral tissues. ketoacidosis can appear after an overnight fast but it typically requires 3 to 14 days of starvation to reach maximal severity. typical keto-anion levels are only 1 to 2 mmol/l and this will usually not alter the anion gap. the acidosis even with quite prolonged fasting is only ever of mild to moderate severity with keto-anion levels up to a maximum of 3 to 5 mmol/l and plasma pH down to 7.3. ketone bodies also stimulate some insulin release from the islets. patients are usually not diabetic. ALCOHOLIC KETOSIS Presentation a chronic alcoholic who has a binge, then stops drinking and has little or no oral food intake for a few days (ethanol and fasting) volume depletion is common and this can result in increased levels of counter regulatory hormones (eg glucagon) levels of free fatty acids (FFA) can be high (eg up to 3.5mM) providing plenty of substrate for the altered hepatic lipid metabolism to produce plenty of ketoanions GI symptoms are common (eg nausea, vomiting, abdominal pain, haematemesis, melaena) acidaemia may be severe (eg pH down to 7.0) plasma glucose may be depressed or normal or Continue reading >>

Beta-hydroxybutyrate

Beta-hydroxybutyrate

The reference range is less than 0.4-0.5 mmol/L. [ 1 , 2 , 3 ] Levels of more than 1 mmol/L require further action, whereas levels of more than 3 mmol/L require immediate medical review. [ 4 ] Elevated serum -hydroxybutyrate levels can be observed in various conditions associated with metabolic substrate use disorders, insulin deficiency, and altered redox status including the following: [ 2 , 5 , 6 ] Diabetic ketoacidosis : Ketone body production is stimulated by dehydration and insulin deficiency. Levels are usually more than 3 mmol/L. Alcoholic ketoacidosis: Ketone body production is stimulated by altered redox status within the liver mitochondria. Fasting and starvation: Serum -hydroxybutyrate levels are increased after approximately 3 days, rising to a plateau after 4 weeks of food deprivation. [ 2 ] Lactation: Ketone body production is stimulated by the high-fat content of milk. [ 2 ] Ketogenic diets: These diets are popular for the control of refractory seizures and body weight in obese individuals. [ 2 ] Glycogen-storage diseases and other metabolic disorders Specimen type: -hydroxybutyrate levels can be measured in serum. Point-of-care devices that can measure -hydroxybutyrate levels in a single drop of blood within 30 seconds have been developed. Most methods for - hydroxybutyrate estimation are rapid enzymatic assays that can be performed in the hospital or the office. [ 2 ] Collection method: For serum -hydroxybutyrate, venipuncture is used. For point-of-care -hydroxybutyrate, a drop of capillary blood is sufficient. Specimen volume: Obtain 0.5 mL for serum examination. The volume required for the point-of-care test is 5-10 L. Determination method: The usual method for -hydroxybutyrate determination in blood or serum involves the use of -hydroxybutyrate deh Continue reading >>

Diabetic Ketoacidosisworkup

Diabetic Ketoacidosisworkup

Author: Osama Hamdy, MD, PhD; Chief Editor: Romesh Khardori, MD, PhD, FACP more... Diabetic ketoacidosis is typically characterized by hyperglycemia over 250 mg/dL, a bicarbonate level less than 18 mEq/L, and a pH less than 7.30, with ketonemia and ketonuria. While definitions vary, mild DKA can be categorized by a pH level of 7.25-7.3 and a serum bicarbonate level between 15-18 mEq/L; moderate DKA can be categorized by a pH between 7.0-7.24 and a serum bicarbonate level of 10 to less than 15 mEq/L; and severe DKA has a pH less than 7.0 and bicarbonate less than 10 mEq/L. [ 17 ] In mild DKA, anion gap is greater than 10 and in moderate or severe DKA the anion gap is greater than 12. These figures differentiate DKA from HHS where blood glucose is greater than 600 mg/dL but pH is greater than 7.3 and serum bicarbonate greater than 15 mEq/L. Laboratory studies for diabetic ketoacidosis (DKA) should be scheduled as follows: Blood tests for glucose every 1-2 h until patient is stable, then every 4-6 h Serum electrolyte determinations every 1-2 h until patient is stable, then every 4-6 h Glaser NS, Marcin JP, Wootton-Gorges SL, et al. Correlation of clinical and biochemical findings with diabetic ketoacidosis-related cerebral edema in children using magnetic resonance diffusion-weighted imaging. J Pediatr. 2008 Jun 25. [Medline] . Umpierrez GE, Jones S, Smiley D, et al. Insulin analogs versus human insulin in the treatment of patients with diabetic ketoacidosis: a randomized controlled trial. Diabetes Care. 2009 Jul. 32(7):1164-9. [Medline] . [Full Text] . Herrington WG, Nye HJ, Hammersley MS, Watkinson PJ. Are arterial and venous samples clinically equivalent for the estimation of pH, serum bicarbonate and potassium concentration in critically ill patients?. Diabet Med. 201 Continue reading >>

Diabetic, Alcoholic And Starvation Ketoacidosis

Diabetic, Alcoholic And Starvation Ketoacidosis

Copious amounts of ketones which are generated in insulin-deficient or insulin-unresponsive patients will give rise to a high anion gap metabolic acidosis. Ketones are anions, and they form the high anion gap. Management of DKA and HONK is discussed elsewhere. Meet the ketones Chemically speaking, a ketone is anything with a carbonyl group between a bunch of other carbon atoms. The above are your three typical ketoacidosis-associated ketone bodies. The biochemistry nerds among us will hasten to add that the beta-hydroxybutyrate is in fact not a ketone but a carboxylic acid, but - because it is associated with ketoacidosis, we will continue to refer to it as a ketone for the remainder of this chapter, in the spirit of convention. In the same spirit, we can suspend our objections to acetone being included in a discussion of ketoacidosis, which (though a true ketone) is in fact not acidic or basic, as it does not ionise at physiological pH (its pKa is 20 or so). So really, the only serious ketone acid is acetoacetate, which has a pKa of 3.77. However, beta-hydroxybutyrate is the prevalent ketone in ketoacidosis; the normal ratio of beta-hydroxybutyrate and acetoacetate is 3:1, and it can rise to 10:1 in diabetic ketoacidosis. Acetone is the least abundant. The metabolic origin of ketones The generation of ketones is a normal response to fasting, which follows the depletion of hepatic glycogen stores. Let us discuss normal physiology for a change. You, a healthy adult without serious alcohol problems, are fasting from midnight for a routine elective hernia repair. You will go to be after dinner with a few nice lumps of undigested food in your intestine, as well as about 75g of hepatic glycogen. As you sleep, you gradually digest the food and dip into the glycogen store. At Continue reading >>

Bhyd - Clinical: Beta-hydroxybutyrate, Serum

Bhyd - Clinical: Beta-hydroxybutyrate, Serum

Serum beta-hydroxybutyrate is a key parameter monitored during controlled 24-hour fasts Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test Beta-hydroxybutyrate (BHB) is 1 of 3 sources of ketone bodies. Its relative proportion in the blood (78%) is greater than the other 2 ketone bodies, acetoacetate (20%) and acetone (2%). During carbohydrate deprivation (starvation, digestive disturbances, frequent vomiting), decreased carbohydrate utilization (diabetes mellitus), glycogen storage diseases, and alkalosis, acetoacetate production increases. The increase may exceed the metabolic capacity of the peripheral tissues. As acetoacetate accumulates in the blood, a small amount is converted to acetone by spontaneous decarboxylation. The remaining and greater portion of acetoacetate is converted to BHB. The beta-hydroxybutyrate (BHB)/acetoacetate ratio is typically between 3:1 and 7:1 in severe ketotic states. Serum BHB increases in response to fasting, but should not exceed 0.4 mmol/L following an overnight fast (up to 12 hours). In pediatric patients, a hypo- or hyper-ketotic state (with or without hypoglycemia) may suggest specific groups of metabolic disorders. Twenty four-hour fasting tests should not be performed in patients <2 years of age. Dipstick serum ketone determination using nitroprusside reagent is often used to estimate ketone body status, but that method has inherent problems. The dipstick does not measure beta-hydroxybutyrate, the most abundant of the physiological ketone bodies; the nitroprusside reagent only reacts with acetoacetate and acetone. Continue reading >>

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