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Capillary versus Serum b-hydroxybutyrate in Pediatric Diabetic Ketoacidosis

Praveen M Kurup1, Ramachandran Rameshkumar2, Rajendran Soundravally3

  • 1Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.

Indian Pediatrics
|March 2, 2019
PubMed

Insights

Point-of-care capillary b-hydroxybutyrate testing shows excellent agreement with serum measurements. This method is a valid tool for monitoring ketonemia in pediatric diabetic ketoacidosis.

Area of Science:

  • Biochemistry
  • Pediatric Endocrinology
  • Clinical Diagnostics

Background:

  • Diabetic ketoacidosis (DKA) is a serious complication in children with diabetes.
  • Accurate and rapid monitoring of ketonemia is crucial for effective DKA management.
  • Serum beta-hydroxybutyrate is a gold standard but requires laboratory analysis.

Purpose of the Study:

  • To evaluate the agreement between point-of-care capillary beta-hydroxybutyrate measurements and traditional serum beta-hydroxybutyrate levels.
  • To determine the clinical utility of a point-of-care device for assessing ketonemia in pediatric DKA.

Main Methods:

  • A study involving 236 paired samples from 26 children under 13 years old with DKA.
  • Capillary beta-hydroxybutyrate measured using a point-of-care device.
  • Serum beta-hydroxybutyrate measured via colorimetric enzymatic estimation.

Main Results:

  • Excellent agreement observed between capillary and serum beta-hydroxybutyrate (intraclass correlation 96.1%).
  • Mean bias was 0.027 (SD 0.78), with 95% limits of agreement from -1.51 to 1.56.
  • Correlation found with blood gas parameters like pH, anion gap, bicarbonate, and CO2 levels.

Conclusions:

  • Point-of-care capillary beta-hydroxybutyrate estimation is a reliable method for monitoring ketonemia in pediatric DKA.
  • This approach offers a convenient and valid alternative to serum testing for rapid clinical decision-making.
Abstract

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