A comparative study on the use of urinary aceto acetic acid versus capillary beta hydroxy butarate in the diagnosis of diabetic ketoacidosis

Abstract

Background: Diabetic ketoacidosis(DKA) is an acute complication of diabetes wherein there is hyperglycaemia, ketosis and metabolic acidosis. In DKA, beta-hydroxybutyrate(BHB) is synthesized at a three-fold greater rate than acetoacetate. Earlier diagnosis is possible with detection of capillary-BHB over acetoacetate in urine. Objectives: To detect ketone bodies by the two methods; urinary acetoacetic acid and Capillary-Betahydroxy butyrate (BHB) and to compare the two methods in the early diagnosis and management of DKA. Methods: Patients presenting with high blood sugars (i.e>250mg/dl) with suspected DKA were tested for Urine ketone bodies, Capillary-BHB and Arterial Blood Gas(ABG) analysis. Patients suspected to have other causes of ketoacidosis like starvation ketoacidosis, alcoholic ketoacidosis were excluded, based on history. Results: In our study comparing capillary-BHB to urine ketone bodies(UKB), 17%(17) of patients had UKB positive with negative BHB and 7%(7) of patients had positive capillary-BHB reading with negative UKB. Of the 17 patients with positive UKB but negative capillary-BHB, two had acidosis on ABG. Of the seven patients with positive capillary-BHB and negative UKB, all had acidosis on ABG. Thus capillary-BHB correlated better with ABG compared to UKB.The average time taken for capillary-BHB measurement by hand-held ketometer was 2.28 minutes versus seven hours for UKB. Conclusion: The hand-held ketometer helps in rapid diagnosis of patients presenting with hyper glycemia. The capillary sample is easy to obtain, and obviates the need for urine samples in dehydrated patients. The capillary-BHB correlates better with ABG and is faster and provides an accurate endpoint for management of DKA in the triage.