Serum beta-hydroxybutyrate measurement in patients with uncontrolled diabetes mellitus

Objective: To assess whether routinely measuring serum beta-hydroxybutyrate (beta-OHB) concentration might help judge the severity of or assist in tre ating patients with suspected ketoacidosis. Methods: Serum beta-OHB level was estimated by a standard enzymatic method in 64 episodes in adults admitted to a municipal hospital. Of the 85 specim ens analyzed, 60 were taken before treatment from a nearly consecutive grou p of diabetic patients with ketosis, 21 were follow-up specimens, and 4 wer e from nondiabetic patients with ketosis. Results: In the 85 specimens, the correlation between serum carbon dioxide and beta-OHB levels was -0.69, and that between anion gap and beta-OHB leve l was 0.75. For just the initial specimens, the respective correlation coef ficients were -0.60 and 0.52. Conclusions: The correlations between serum beta-OHB and carbon dioxide lev els and the anion gap were close, but not sufficiently so for the beta-OHB measurements to be routinely useful alone to assess the severity of the ket oacidosis. Full laboratory assessment of the severity and characteristics o f ketoacidosis also requires knowledge of serum carbon dioxide level, anion gap, often blood pH, and ideally serum acetoacetate and lactate concentrat ions as well as serum beta-OHB concentration.