We quantitated serial serum beta-hydroxybutyrate (beta -OHB) levels using t
he Ketosite method in 9 children with IDDM who were treated for diabetic ke
toacidosis (DKA) and compared them to urinary ketone measurements by dipsti
ck. Persistent elevations of serum beta -OHB were seen in six patients when
the urine became clear of ketones; five of these patients had a recurrence
of ketonuria. We conclude that many patients recovering from ketoacidosis
have continuing elevations of beta -OHB after the urine is free of ketones
and this unrecognized abnormality is the likely cause of recurrence of the
ketonuria. We recommend that fluid therapy be continued beyond clearance of
ketonuria and suggest using the Ketosite method to document restoration of
normal serum beta -OHB levels in patients recovering from DKA.