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What Is Ketoacidosis Test

Point-of-care Screening For Diabetic Ketoacidosis

Point-of-care Screening For Diabetic Ketoacidosis

Summarized from Arora S, Henderson S, Long T, Menchine M. Diagnostic accuracy of point of care testing for diabetic ketoacidosis at Emergency Department triage. Diabetes Care 2011; 34: 852-54 Diabetic ketoacidosis (DKA), a common acute and potentially life-threatening complication of diabetes that results from insulin deficiency, is characterized by raised blood glucose (hyperglycemia) and metabolic acidosis. Metabolic acidosis occurs due to abnormal accumulation in blood of ketoacids, principally ß-hydroxybutyric acid and acetoacetic acid. In an emergency care setting it is common practice to screen all patients with hyperglycemia for DKA using urine dipstick testing for the presence of ketones (i.e. the two ketoacids and acetone, a metabolite of acetoacetic acid). An alternative approach is now available, made possible by the development of point-of-care analyzers that allow rapid (within 1 minute) estimation of serum ß-hydroxybutyrate concentration from a drop of venous blood. The latest of several studies comparing the reliability of traditional urine dipstick testing with that of the newer point-of-care blood testing to diagnose DKA is recently published. The study population comprised 516 patients who on routine triage testing following admission to the emergency department of a Californian hospital were found to have blood glucose in excess of 250 mg/dL (13.9 mmol/L). All were submitted for DKA screening using both urine dipstick testing for ketones and point-of-care blood measurement of serum ß-hydroxybutyrate concentration. A diagnosis of DKA was ultimately confirmed in 54 of the 516 hyperglycemic patients. Urine dipstick testing for ketones was positive in 53 of the 54 patients with DKA (sensitivity 98.1 %) but was also positive in 300 of the 462 patients w Continue reading >>

> Hyperglycemia And Diabetic Ketoacidosis

> Hyperglycemia And Diabetic Ketoacidosis

When blood glucose levels (also called blood sugar levels) are too high, it's called hyperglycemia. Glucose is a sugar that comes from foods, and is formed and stored inside the body. It's the main source of energy for the body's cells and is carried to each through the bloodstream. But even though we need glucose for energy, too much glucose in the blood can be unhealthy. Hyperglycemia is the hallmark of diabetes — it happens when the body either can't make insulin (type 1 diabetes) or can't respond to insulin properly (type 2 diabetes). The body needs insulin so glucose in the blood can enter the cells to be used for energy. In people who have developed diabetes, glucose builds up in the blood, resulting in hyperglycemia. If it's not treated, hyperglycemia can cause serious health problems. Too much sugar in the bloodstream for long periods of time can damage the vessels that supply blood to vital organs. And, too much sugar in the bloodstream can cause other types of damage to body tissues, which can increase the risk of heart disease and stroke, kidney disease, vision problems, and nerve problems in people with diabetes. These problems don't usually show up in kids or teens with diabetes who have had the disease for only a few years. However, they can happen in adulthood in some people, particularly if they haven't managed or controlled their diabetes properly. Blood sugar levels are considered high when they're above someone's target range. The diabetes health care team will let you know what your child's target blood sugar levels are, which will vary based on factors like your child's age. A major goal in controlling diabetes is to keep blood sugar levels as close to the desired range as possible. It's a three-way balancing act of: diabetes medicines (such as in Continue reading >>

Diabetic Ketoacidosis Workup

Diabetic Ketoacidosis Workup

Approach Considerations 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: Repeat laboratory tests are critical, including potassium, glucose, electrolytes, and, if necessary, phosphorus. Initial workup should include aggressive volume, glucose, and electrolyte management. It is important to be aware that high serum glucose levels may lead to dilutional hyponatremia; high triglyceride levels may lead to factitious low glucose levels; and high levels of ketone bodies may lead to factitious elevation of creatinine levels. Continue reading >>

What Is Ketoacidosis Symptoms And What Are The Effects In Someone Who Is A Non Diabetic?

What Is Ketoacidosis Symptoms And What Are The Effects In Someone Who Is A Non Diabetic?

In my experience.. the most obvious ketoacidosis symptom when you are required to be delivered to the hospital.. was when a nonstop pain as if being constantly pierced deeper and deeper into the stomach to liver/pancreas area by a dagger. I’ve had around 10 years experience with ketoacidosis due to horrible control of my type 1 diabetes. The regular symptoms leading up to ketoacidosis or process of it is generally frequent urination, dry mouth, and constant high glucose levels. There are of course also ketone urination test strips that can be taken to see how high of a level of ketones has accumulated in your body. And sorry I cannot answer the effects for non-diabetics. The above is just my experience as a type 1 (16 years by now) diabetic. Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Patient professional reference Professional Reference articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use. You may find the Pre-diabetes (Impaired Glucose Tolerance) article more useful, or one of our other health articles. See also the separate Childhood Ketoacidosis article. Diabetic ketoacidosis (DKA) is a medical emergency with a significant morbidity and mortality. It should be diagnosed promptly and managed intensively. DKA is characterised by hyperglycaemia, acidosis and ketonaemia:[1] Ketonaemia (3 mmol/L and over), or significant ketonuria (more than 2+ on standard urine sticks). Blood glucose over 11 mmol/L or known diabetes mellitus (the degree of hyperglycaemia is not a reliable indicator of DKA and the blood glucose may rarely be normal or only slightly elevated in DKA). Bicarbonate below 15 mmol/L and/or venous pH less than 7.3. However, hyperglycaemia may not always be present and low blood ketone levels (<3 mmol/L) do not always exclude DKA.[2] Epidemiology DKA is normally seen in people with type 1 diabetes. Data from the UK National Diabetes Audit show a crude one-year incidence of 3.6% among people with type 1 diabetes. In the UK nearly 4% of people with type 1 diabetes experience DKA each year. About 6% of cases of DKA occur in adults newly presenting with type 1 diabetes. About 8% of episodes occur in hospital patients who did not primarily present with DKA.[2] However, DKA may also occur in people with type 2 diabetes, although people with type 2 diabetes are much more likely to have a hyperosmolar hyperglycaemic state. Ketosis-prone type 2 diabetes tends to be more common in older, overweight, non-white people with type 2 diabetes, and DKA may be their Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a serious problem that can occur in people with diabetes if their body starts to run out of insulin. This causes harmful substances called ketones to build up in the body, which can be life-threatening if not spotted and treated quickly. DKA mainly affects people with type 1 diabetes, but can sometimes occur in people with type 2 diabetes. If you have diabetes, it's important to be aware of the risk and know what to do if DKA occurs. Symptoms of diabetic ketoacidosis Signs of DKA include: needing to pee more than usual being sick breath that smells fruity (like pear drop sweets or nail varnish) deep or fast breathing feeling very tired or sleepy passing out DKA can also cause high blood sugar (hyperglycaemia) and a high level of ketones in your blood or urine, which you can check for using home-testing kits. Symptoms usually develop over 24 hours, but can come on faster. Check your blood sugar and ketone levels Check your blood sugar level if you have symptoms of DKA. If your blood sugar is 11mmol/L or over and you have a blood or urine ketone testing kit, check your ketone level. If you do a blood ketone test: lower than 0.6mmol/L is a normal reading 0.6 to 1.5mmol/L means you're at a slightly increased risk of DKA and should test again in a couple of hours 1.6 to 2.9mmol/L means you're at an increased risk of DKA and should contact your diabetes team or GP as soon as possible 3mmol/L or over means you have a very high risk of DKA and should get medical help immediately If you do a urine ketone test, a result of more than 2+ means there's a high chance you have DKA. When to get medical help Go to your nearest accident and emergency (A&E) department straight away if you think you have DKA, especially if you have a high level of ketones in Continue reading >>

Diagnostic Accuracy Of Point-of-care Testing For Diabetic Ketoacidosis At Emergency-department Triage

Diagnostic Accuracy Of Point-of-care Testing For Diabetic Ketoacidosis At Emergency-department Triage

OBJECTIVE In the emergency department, hyperglycemic patients are screened for diabetic ketoacidosis (DKA) via a urine dipstick. In this prospective study, we compared the test characteristics of point-of-care β-hydroxybutyrate (β-OHB) analysis with the urine dipstick. RESEARCH DESIGN AND METHODS Emergency-department patients with blood glucose ≥250 mg/dL had urine dipstick, chemistry panel, venous blood gas, and capillary β-OHB measurements. DKA was diagnosed according to American Diabetes Association criteria. RESULTS Of 516 hyperglycemic subjects, 54 had DKA. The urine dipstick had a sensitivity of 98.1% (95% CI 90.1–100), a specificity of 35.1% (30.7–39.6), a positive predictive value of 15% (11.5–19.2), and a negative predictive value of 99.4% (96.6–100) for DKA. Using the manufacturer-suggested cutoff of >1.5 mmol/L, β-OHB had a sensitivity of 98.1% (90.1–100), a specificity of 78.6% (74.5–82.2), a positive predictive value of 34.9% (27.3–43), and a negative predictive value of 99.7% (98.5–100) for DKA. CONCLUSIONS Point-of-care β-OHB and the urine dipstick are equally sensitive for detecting DKA (98.1%). However, β-OHB is more specific (78.6 vs. 35.1%), offering the potential to significantly reduce unnecessary DKA work-ups among hyperglycemic patients in the emergency department. RESEARCH DESIGN AND METHODS This prospective, observational study was conducted at a large, urban emergency department. Institutional review board approval was obtained, and study participants provided written informed consent. The cohort studied represents a convenience sample of emergency-department patients with triage capillary blood glucose ≥250 mg/dL enrolled on 320 individual days over a 2-year period based on research-assistant availability. Subjects we Continue reading >>

Point-of-care Blood Test For Ketones In Patients With Diabetes: Primary Care Diagnostic Technology Update

Point-of-care Blood Test For Ketones In Patients With Diabetes: Primary Care Diagnostic Technology Update

Go to: PREVIOUS RESEARCH Accuracy compared to existing technology The POC blood ketone test meter measures the ketone 3-beta-hydroxybutyrate (beta-OHB) in the blood of patients with diabetes. In comparison to the standard laboratory enzymatic method the ketone sensor accurately measured beta-OHB concentrations in patients with DKA (limits of agreement [LOA] 0.9 to 1.0 mmol/l) or starvation-induced ketonaemia (LOA-0.5 to +0.5 mmol/l).7 In an emergency department (ED) study of 173 hyperglycaemic patients, POC blood ketone tests were compared to urine dipstick analysis.8 Several cut-off points were evaluated. At a beta-OHB value <3 mmol/l or ketonuria ≤1+, ketoacidosis could be excluded (negative predictive value 100%). At 2+ cut-off points for ketonuria and at the 3 mmol/l cut-off point for ketonaemia the two tests had the same sensitivity (100%), but the specificity of beta-OHB (94%) was significantly higher (P<0.001) than that of ketonuria (77%). Overall the study showed that measurement of beta-OHB in capillary blood was faster and more effective than the use of urine dipsticks to detect ketoacidosis. A follow-up study by the same group on the correlation between urine and capillary blood ketones showed a good correlation for low values, but a poor correlation for high values. The study concluded that either test could be used to exclude ketosis, but that the capillary blood ketone test is more accurate to confirm ketoacidosis.9 A prospective observational study in an ED comparing ketone dipstick testing with capillary blood ketone testing, showed that the positive likelihood ratio (LR+) for DKA was 3 using urine ketone dipstick testing, and 4 for capillary blood ketone testing. In determining hyperketonaemia (both in diabetic ketosis and diabetic ketoacidosis) the L Continue reading >>

Ketones Blood Test

Ketones Blood Test

Acetone bodies; Ketones - serum; Nitroprusside test; Ketone bodies - serum; Ketones - blood; Ketoacidosis - ketones blood test A ketone blood test measures the amount of ketones in the blood. How the Test is Performed How to Prepare for the Test No preparation is needed. How the Test will Feel When the needle is inserted to draw blood, some people feel slight pain. Others feel a prick or stinging. Afterward, there may be some throbbing or a slight bruise. This soon goes away. Why the Test is Performed Ketones are substances produced in the liver when fat cells break down in the blood. This test is used to diagnose ketoacidosis. This is a life-threatening problem that affects people who: Have diabetes. It occurs when the body cannot use sugar (glucose) as a fuel source because there is no insulin or not enough insulin. Fat is used for fuel instead. When fat breaks down, waste products called ketones build up in the body. Drink large amounts of alcohol. Normal Results A normal test result is negative. This means there are no ketones in the blood. Normal value ranges may vary slightly among different laboratories. Some labs use different measurements or test different samples. Talk to your health care provider about the meaning of your specific test results. What Abnormal Results Mean A test result is positive if ketones are found in the blood. This may indicate: Other reasons ketones are found in the blood include: A diet low in carbohydrates can increase ketones. After receiving anesthesia for surgery Glycogen storage disease (condition in which the body can't break down glycogen, a form of sugar that is stored in the liver and muscles) Being on a weight-loss diet Risks Veins and arteries vary in size from one person to another and from one side of the body to the other. Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus.[1] Signs and symptoms may include vomiting, abdominal pain, deep gasping breathing, increased urination, weakness, confusion, and occasionally loss of consciousness.[1] A person's breath may develop a specific smell.[1] Onset of symptoms is usually rapid.[1] In some cases people may not realize they previously had diabetes.[1] DKA happens most often in those with type 1 diabetes, but can also occur in those with other types of diabetes under certain circumstances.[1] Triggers may include infection, not taking insulin correctly, stroke, and certain medications such as steroids.[1] DKA results from a shortage of insulin; in response the body switches to burning fatty acids which produces acidic ketone bodies.[3] DKA is typically diagnosed when testing finds high blood sugar, low blood pH, and ketoacids in either the blood or urine.[1] The primary treatment of DKA is with intravenous fluids and insulin.[1] Depending on the severity, insulin may be given intravenously or by injection under the skin.[3] Usually potassium is also needed to prevent the development of low blood potassium.[1] Throughout treatment blood sugar and potassium levels should be regularly checked.[1] Antibiotics may be required in those with an underlying infection.[6] In those with severely low blood pH, sodium bicarbonate may be given; however, its use is of unclear benefit and typically not recommended.[1][6] Rates of DKA vary around the world.[5] In the United Kingdom, about 4% of people with type 1 diabetes develop DKA each year, while in Malaysia the condition affects about 25% a year.[1][5] DKA was first described in 1886 and, until the introduction of insulin therapy in the 1920s, it was almost univ Continue reading >>

What Is The Dumbest Reason You Have Seen For Someone To Go To The Hospital?

What Is The Dumbest Reason You Have Seen For Someone To Go To The Hospital?

I kid you not. I was a junior doctor at a busy London A&E department, where queues were piling up of people waiting to be seen. There was an array of the usual presentations, including the breathless asthmatic, a couple of chest pains, renal colics, nausea and vomiting and so on as expected. What I never expected, was this young woman who had waited almost 3 hours to be seen, who presented with what was essentially a papercut. She was wearing smart office attire, and reported to have nicked her finger on a filing folder at her office, sustaining a superficial cut of about 4cm length. After wondering how this case had gotten past the triage nurse, I asked if the cut was painful. “Not so much now”, the woman said. I asked if she'd washed it at all. “Yes,” she told me. Then I asked what her concern was. She articulated to me that her worry was to catch an infection since the cut was so long, and she didn't want to risk having her finger amputated or anything drastic as such. With all the calm I could possible muster, after reassuring the woman that she wouldn't be needing any amputations, I explained that this was not an emergency. She did not have to wait the 3 hours to be seen, nor taken up emergency department time and resources, and that basic first aid would have been sufficient. She apologised, thanked me and left with a fresh Band-Aid on her finger. Continue reading >>

Is Keto Healthy? Ketosis Vs Ketoacidosis

Is Keto Healthy? Ketosis Vs Ketoacidosis

Is Keto Healthy? Ketosis vs Ketoacidosis When looking at a ketogenic diet and ketosis, it’s common for some people to confuse the process with a harmful, more extreme version of this state known as diabetic ketoacidosis. But there are a lot of misconceptions out there about ketosis vs ketoacidosis, and it’s time to shed some light on the subject by looking at the (very big) differences between the two. An Overview of Ketosis A ketogenic, or keto, diet is centered around the process of ketosis, so it’s important to understand exactly what ketosis is first before we get into whether or not it’s safe (spoiler: it is): Ketosis is a metabolic state where the body is primarily using fat for energy instead of carbohydrates. Burning carbohydrates (glucose) for energy is the default function of the body, so if glucose is available, the body will use that first. But during ketosis, the body is using ketones instead of glucose. This is an amazing survival adaptation by the body for handling periods of famine or fasting, extreme exercise, or anything else that leaves the body without enough glucose for fuel. Those eating a ketogenic diet purposely limit their carb intake (usually between 20 and 50 grams per day) to facilitate this response. That’s why the keto diet focuses on very low carb intake, moderate to low protein intake, and high intakes of dietary fats. Lower protein is important because it prevents the body from pulling your lean muscle mass for energy and instead turns to fat. Ketone bodies are released during ketosis and are created by the liver from fatty acids. These ketones are then used by the body to power all of its biggest organs, including the brain, and they have many benefits for the body we’ll get into later. But first, let’s address a common mi Continue reading >>

Ketoacidosis

Ketoacidosis

Ketones in the urine, as detected by urine testing stix or a blood ketone testing meter[1], may indicate the beginning of diabetic ketoacidosis (DKA), a dangerous and often quickly fatal condition caused by low insulin levels combined with certain other systemic stresses. DKA can be fixed if caught quickly. Diabetics of all species therefore need to be checked for ketones with urine testing stix, available at any pharmacy, whenever insulin level may be too low, and any of the following signs or triggers are present: Ketone Monitoring Needed: Little or no insulin in last 12 hours High blood sugar over 16 mmol/L or 300 mg/dL (though with low insulin, lower as well...) Dehydration (skin doesn't jump back after pulling a bit gums are tacky or dry)[2] Not eating for over 12 hours due to Inappetance or Fasting Vomiting Lethargy Infection or illness High stress levels Breath smells like acetone (nail-polish remover) or fruit. Note that the triggers and signs are somewhat interchangeable because ketoacidosis is, once begun, a set of vicious circles which will make itself worse. So dehydration, hyperglycemia, fasting, and presence of ketones are not only signs, they're also sometimes triggers. In a diabetic, any urinary ketones above trace, or any increase in urinary ketone level, or trace urinary ketones plus some of the symptoms above, are cause to call an emergency vet immediately, at any hour of the day. Possible False Urine Ketone Test Results Drugs and Supplements Valproic Acid (brand names) Depakene, Depakote, Divalproex Sodium[3] Positive. Common use: Treatment of epilepsy. Cefixime/Suprax[4] Positive with nitroprusside-based urine testing. Common use: Antibiotic. Levadopa Metabolites[5] Positive with high concentrations[6]. Tricyclic Ring Compounds[7][8] Positive. Commo Continue reading >>

Ketones Blood Test

Ketones Blood Test

Acetone bodies; Ketones - serum; Nitroprusside test; Ketone bodies - serum; Ketones - blood; Ketoacidosis - ketones blood test A ketone blood test measures the amount of ketones in the blood. How the Test is Performed How to Prepare for the Test No preparation is needed. How the Test will Feel When the needle is inserted to draw blood, some people feel slight pain. Others feel a prick or stinging. Afterward, there may be some throbbing or a slight bruise. This soon goes away. Why the Test is Performed Ketones are substances produced in the liver when fat cells break down in the blood. This test is used to diagnose ketoacidosis. This is a life-threatening problem that affects people who: Have diabetes. It occurs when the body cannot use sugar (glucose) as a fuel source because there is no insulin or not enough insulin. Fat is used for fuel instead. When fat breaks down, waste products called ketones build up in the body. Drink large amounts of alcohol. Normal Results A normal test result is negative. This means there are no ketones in the blood. Normal value ranges may vary slightly among different laboratories. Some labs use different measurements or test different samples. Talk to your health care provider about the meaning of your specific test results. What Abnormal Results Mean A test result is positive if ketones are found in the blood. This may indicate: Other reasons ketones are found in the blood include: A diet low in carbohydrates can increase ketones. After receiving anesthesia for surgery Glycogen storage disease (condition in which the body can't break down glycogen, a form of sugar that is stored in the liver and muscles) Being on a weight-loss diet Risks Veins and arteries vary in size from one person to another and from one side of the body to the other. Continue reading >>

New Quantitative Test Ketone Beta-hydroxybutyrate

New Quantitative Test Ketone Beta-hydroxybutyrate

Effective December 13, 2016, TriCore changed to a new quantitative test to measure ketones in plasma or serum. The new test, Ketone Beta-hydroxybutyrate (KETBHB), measures Beta-hydroxybutyrate (BHB) and is not directly comparable to the previous test measuring acetoacetate. BHB shows different clearance during treatment of ketoacidosis. As diabetic ketoacidosis (DKA) is treated, serum BHB decreases more consistently than acetoacetate which is converted to BHB and does not change as rapidly. CLINICAL UTILITY BHB is the predominate ketone present during DKA and trends with a patient’s clinical status. Because KETBH is quantitative, it can be used for monitoring ketosis to resolution. Additionally, BHB can be used to clinically diagnose and monitor the disease status or severity of alcoholism, glycogen storage disease, high fat/low carbohydrate diets, pregnancy, alkalosis, ingestion of isopropyl alcohol, and salicylate poisoning. In these situations the levels are usually above the normal range which is up to 0.27 mml/L, but often do not reach the threshold for DKA diagnosis. RESULTS INTERPRETATION FOR BETA-HYDROXYBUTYRATE LEVELS Range mmol/dL Interpretation Sensitivity for DKA Specificity for DKA <0.27 no ketoacidosis, normal range 0.28-1.5 DKA not entirely excluded, other conditions should be considered 1.5-3.0 children DKA possible in diabetics with >250mg/dL glucose 98-100% 78-93% 1.5-3.8 adults DKA possible in diabetics with >250mg/dL glucose 98-100% 78-93% >3.0 children >3.8 adults Near diagnostic of DKA in diabetic patient near 100% 93-94% 1. A Beta-hyroxybutyrate level of more than 1.5 mmol/L had sensitivity ranging from 98-100% and specificity ranging from 78.6-93.3% for the diagnosis of diabetic ketoacidosis in diabetic patients presenting to the Emergency Continue reading >>

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