Serum ketone body measurement in patients with diabetic ketoacidosis.
Level 4 - case-series / case-control
Retrospective observational cohort / diagnostic accuracy study
PubMed 36117923 · doi:10.1007/s13340-022-00581-2
What was done
A retrospective study evaluated 72 patients presenting with hyperglycemia to an outpatient clinic or emergency department between 2011 and 2019 who had simultaneous blood gas and quantitative serum ketone body measurements. Patients with non-diabetic causes of ketosis were excluded. Investigators assessed correlations between ketone bodies and blood gas parameters (bicarbonate and pH) and performed receiver-operating-characteristic (ROC) curve analyses to determine diagnostic cut-off thresholds for diabetic ketoacidosis (DKA).
What was found
Serum ketone bodies correlated negatively with blood HCO3- and pH (exact correlation coefficients not reported in the abstract). Optimal ROC diagnostic cut-off values for DKA were 6.3 mmol/L for beta-hydroxybutyrate, 1.4 mmol/L for acetoacetate, and 8.0 mmol/L for total ketone bodies. The authors reported that these cut-off values were higher than those in prior literature and that serum ketone bodies also helped differentiate type 1 from type 2 diabetes mellitus.
Why it matters
This study provides specific quantitative thresholds for individual and total serum ketone bodies that may aid in establishing objective laboratory criteria for diagnosing DKA.
Limits
The study is limited by a small sample size (n = 72) and a retrospective design. The abstract does not report exact correlation coefficients, area under the ROC curve (AUC), sensitivity, specificity, or confidence intervals, and the higher-than-usual cut-offs lack external prospective validation.
Cited by
- supports Diabetic ketoacidosis is characterized by high glucose levels, deficient or near complete absence of insulin, and unregulated ketone levels that can exceed 10 millimolar.