A review of capillary β-hydroxybutyrate cut-off levels for the exclusion and identification of diabetic ketoacidosis.
Level 5 - mechanism / opinion, no new human data
Narrative review with systematic search approach synthesizing 11 primary studies without meta-analysis
PubMed 42023700 · doi:10.1111/jdi.70317
What was done
A narrative review using a systematic search strategy across MEDLINE, Embase, and Emcare was conducted to evaluate capillary beta-hydroxybutyrate (β-OHB) cut-offs for diabetic ketoacidosis (DKA). Studies examining suspected DKA in individuals aged 16 years or older were included. Non-English language publications, animal studies, case reports, and studies evaluating only serum β-OHB were excluded. From 1,177 identified records, 11 primary studies met inclusion criteria.
What was found
To exclude DKA in patients with hyperglycemia, capillary β-OHB cut-offs of <1.0 mmol/L and <1.5 mmol/L were most frequently recommended. A capillary β-OHB cut-off >3.0 mmol/L demonstrated high sensitivity and specificity for identifying DKA. Exact numerical values for sensitivity, specificity, and predictive values were not reported in the abstract.
Why it matters
Point-of-care capillary β-OHB testing offers rapid clinical stratification in suspected DKA, providing practical decision thresholds (<1.5 mmol/L to rule out, >3.0 mmol/L to rule in) for acute care settings.
Limits
The paper is a narrative review without quantitative meta-analytic pooling. Specific statistical performance metrics (sensitivity, specificity, confidence intervals) are omitted from the abstract. The findings exclude pediatric populations under 16 years of age, and utility in prehospital environments remains unvalidated.
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.