Posters Presentations: P3-501–P2-720

In diabetic ketoacidosis (DKA), hydroxy butyrate (OHB) is the major ketone body accumulated in blood. During treatment of DKA, OHB is converted to acetoacetate and acetone which are excreted in the urine. Venous OHB level is the preferred test for monitoring metabolic status in DKA but cost and unavailability limits its use. Ketone monitoring is usually done semiquantitatively by measuring urinary ketones. However, persistence of ketones in the urine, despite metabolic improvement is seen due to the above mentioned limitations. We aimed to compare the sensitivity of capillary OHB by electrochemical method with urinary ketone measurement during treatment of DKA Patients with DKA admitted to the hospital were followed with simultaneous measurements of fingerstick capillary OHBmeasured by electrochemical method (Medisense Optium, Abbott), and urinary ketone by dipstick method. Blood gases were measured in 2-4 hrs intervals. The relationship between simultaneous measurements of urine ketone, blood ketone, blood pH and HCO3 were investigated. 14 patients with DKA (7 M, 7 F, Age: 9.2 4.2 yr) were included with 50 simultaneous measurements of capillary and urinary ketone. Blood gases were assessed 2-4 hourly. No correlation was detected between urine ketone and blood PH (p=0.06) and HCO3 (p=0.79) while a significant negative correlation was found between capillary blood ketone and blood pH (r:-0.41, p <0.05) and HCO3 (r:-0.35, p<0.05). Capillary OHB and urine ketones did not correlate at the beginning and 3.3 1.4 hrs after treatment, but did correlate in the third samples taken 7.8 2.0 hrs after treatment (p<0.05). We conclude that capillary blood OHB level shows good correlation with the degree of acidosis (pH and HCO3) during DKA management. Capillary OHB is more sensitive than urinary ketone measurement in reflecting the patient's metabolic status and improvement during treatment.

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