Type of test Blood

Normal findings

 < 0.4-0.5 mmol/L Possible critical values > 3 mmol/L

 Test explanation and related physiology

 Beta-hydroxybutyrate is the main metabolic product in ketoacidosis. The most clinically relevant application of serum β-hydroxybutyrate determination involves the diagnosis, management, and monitoring of diabetic ketoacidosis (DKA). Although significantly less common than DKA, alcoholic keto acidosis is the second most common cause of ketoacidosis.

 β-hydroxybutyrate is the most abundant ketone body produced during DKA. Many studies have demonstrated the superiority of blood β-hydroxybutyrate levels versus urine ketones in patients with DKA. During states of insulin deficiency, lipolysis of the adipose tissue provides a huge fatty acid load to the liver. Fatty acids are initially metabolized to acetyl-coenzyme A, which cannot enter the citric acid cycle in the mitochondria of the cell due to oxaloacetate deficiency. Thus acetyl-coenzyme A is diverted to ketones through the activity of several enzymes, producing acetoacetate. Acetoacetate is then reduced to 3-β-hydroxybutyrate by 3-β-hydroxybutyrate dehydrogenase.

Test results showing beta-hydroxybutyrate levels greater than 1 mmol/L require further action. Levels above 3 mmol/L require immediate medical evaluation. Elevated levels are diagnostic of DKA, but in the absence of concomitant hyperglycemia, alcoholic ketoacidosis is suspected.

Procedure and patient care

• See inside front cover for Routine Blood Testing.

 • Fasting: No

• Blood tube commonly used: Red

• Point-of-care devices can measure levels in a single drop of capillary blood within 30 seconds.

Abnormal findings

- Elevated Levels

- Diabetic ketoacidosis

- Alcoholic ketoacidosis

- High-fat diet

- Steroid of growth hormone deficiency

- Salicylate poisoning

- Fasting and starvation Lactation

- Ketogenic diets

مواضيع ذات صلة

Bence Jones protein (Free kappa and lambda light chains)

Arthroscopy

The Binding Molecule

Biological Variation

Antismooth muscle antibody (ASMA)

Antinuclear Antibody (ANA)

anticardiolipin antibodies (aCL antibodies, ACA, Antiphospholipid antibodies, Lupus anticoagulant)

Amyloid beta protein precursor, soluble (sBPP, APP, and Tau protein)

Amylase

Ammonia level

Amino acid profiles (Amino acid screen)

Alpha defensin test (Synovasure)