Beta-Hydroxybutyrate LiquiColor® assay


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An introduction to Beta-Hydroxybutyrate


The Stanbio Chemistry LiquiColor® Beta-Hydroxybutyrate (B-HB) reagent is used to detect ketones to identify patients suffering from diabetic ketoacidosis, amongst many other clinical applications.

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Beta-hydroxybutyrate is the best test for monitoring ketosis


Beta-Hydroxybutyrate is the most predominate ketone present during DKA and trends with a patient’s clinical status. Since the Beta-Hydroxybutyrate assay is quantitative it can be used for monitoring ketosis to resolution, making it the superior ketone test.

Our Beta-Hydroxybutyrate reagent is used by over 1,100 hospitals in the USA and can be run on an open channel of a laboratory analyzer. 

In addition, Beta-Hydroxybutyrate can be used to clinically diagnose and monitor the disease status or severity of alcoholism, glycogen storage disease, high fat/low carbohydrate diets, pregnancy, alkalosis, ingestion of isopropyl alcohol, and salicylate poisoning.

Beta-Hydroxybutyrate specifications


Beta-Hydroxybutyrate LiquiColor®

Methodology Key Features Contents Reference No.
Beta-Hydroxybutyrate Dehydrogenase / INT Ready-to-use liquid reagents
Linear up to 8.0 mmol/L
Read @ 505 nm 

R1: 1 x 50 mL

R2: 1 x 8.5 mL

STD: 1 x 3 mL (1 mmol/L)

2440-058

Beta-Hydroxybutyrate LiquiColor® Test (Beckman Synchron CX/LX/DX)

Methodology Key Features Contents Reference No.
Beta-Hydroxybutyrate Dehydrogenase / INT

Linear up to 8.0 mmol/L

Read @ 520 nm

2 x 90 tests

B2440-180

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Why testing for diabetic ketoacidosis?


People with type 1 diabetes may be at risk when they do not have enough insulin, a hormone the body uses to break down sugar (glucose) in the blood for energy. When the body senses glucose is not available, fat is broken down instead.

As fats are broken down, acids called ketones build up in the blood and urine. Ketones are poisonous in high levels. This condition is called ketoacidosis.

Blood glucose levels rise (usually higher than 200 mg/dL) because the liver makes glucose to try to combat the problem. However the cells cannot pull in that glucose without insulin.

Symptoms can include rapid deep breathing, dry skin and mouth, flushed face, fruity smelling breath, nausea, vomiting and stomach pain.

Other symptoms that can occur are; abdominal pain, breathing difficulty while lying down, decreased appetite, decreased consciousness, muscle stiffness and aches, dulled senses that may worsen to a coma and frequent urination and thirst that lasts for a day or more.

 

Why is Beta-Hydroxybutyrate the best test for ketoacidosis diagnosis?


When the body begins to break down its stored fats in response to a low supply of energy (glucose) it produces the ketone Beta-Hydroxybutyrate (B-HB), which is further catabolised into acetoacetate and then into acetone.

Ketones (like glucose) can be tested or monitored in either urine or blood. Many hospitals still use the nitroprusside method for confirming  ketoacidosis. The nitroprusside urine method is efficient at providing  qualitative assessment of ketosis and ketoacidosis by detecting both acetoacetate and acetone. However, nitroprusside methods do not detect Beta-Hydroxybutyrate.

 

B-HB is a better test for ketosis and ketoacidosis than nitroprusside methods for a number of reasons:

  1. Beta-Hydroxybutyrate demonstrates excellent stability, making it the most reliable indicator of clinically relevant ketosis and ketoacidosis.
  2. During ketosis, Beta-Hydroxybutyrate levels increase more than levels of acetone and acetoacetate, clearly indicating the patient's trend in metabolic status.
  3. Quantitative, objective Beta-Hydroxybutyrate results provide a better tool for differentiating metabolic acidosis and monitoring therapy.

beta-hydroxybutyrate-Diabetic-Ketoacidosis

EKF-Ketosis-Guide.jpg

A guide to ketosis and B-HB

The detection of ketosis is important in several clinical conditions. The most important is the detection of potentially fatal ketoacidosis in diabetics. 

These fats are metabolized in the liver and this metabolism produces chemical byproducts called ketones. The buildup of ketones can prove fatal a condition known as acidosis.

 

Read our full guide

Beta-Hydroxybutyrate supporting information


Metabolic Disturbances that Lead to B-HB and Ketone Bodies

 

videoHolder-Metabolic-Disturbances-Lead-Beta-Hydroxybutyrate-Ketone.jpg

James. H Nichols, PhD, DABCC, FACB
Pathology Grand Rounds at mid-west medical school

Beta-Hydroxybutyrate – Uses in the ICU Especially in the Setting of DKA

 

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Mark. H Oltermann MD
JPS Physician Group, John Peter Smith Hospital, Fort Worth, Texas

The Value Efficacy and Efficiency of Beta-Hydroxybutyrate

 

videoHolder-Efficacy-Efficiency-Beta-Hydroxybutyrate.jpg

James. H Nichols, PhD, DABCC, FACB
The 2012 Clinical Lab Expo in Los Angeles

References


  1. Savage MW, Dhatariya KK, Kilvert A, Rayman G, Rees JA, Courtney CH, et al. Joint British Diabetes Societies guideline for the management of diabetic ketoacidosis. Diabet Med. May 2011;28(5):508-15. [Medline].
  2. Joint British Diabetes Societies Inpatient Care Group. The Management of Diabetic Ketoacidosis in Adults. March 2010. Available at http://www.diabetes.nhs.uk/document.php?o=1336 Accessed June 27, 2011.
  3.  Wallace TM, Matthews DR. Recent advances in the monitoring and management of diabetic ketoacidosis. QJM. Dec 2004;97(12):773-80. [Medline].
  4. Timmons JA, Myer P, Maturen A, et al. Use of beta-hydroxybutyric acid levels in the emergency department. Am J Ther. May 1998;5(3):159-63. [Medline].
  5. Taboulet P, Haas L, Porcher R, et al: Urinary acetoacetate or capillary beta-hydroxybutyrate for the diagnosis of ketoacidosis in the Emergency Department setting. Eur J Emerg Med 2004; 11(5):251-258.
  6. Carragher FM, Bonham JR, & Smith JM: Pitfalls in the measurement of some intermediary metabolites.. Ann Clin Biochem 2003; 40(4):313-320.
  7. Arora S, Henderson SO, Long T, Menchine M. Diagnostic Accuracy of Point-of- Care Testing for Diabetic Ketoacidosis at Emergency-Department Triage: {beta}-Hydroxybutyrate versus the urine dipstick. Diabetes Care. Apr 2011;34(4):852-4. [Medline]. [Full Text].
  8. Arora S, Henderson SO, Long T, Menchine M. Diagnostic Accuracy of Point-of- Care Testing for Diabetic Ketoacidosis at Emergency-Department Triage: {beta}-Hydroxybutyrate versus the urine dipstick. Diabetes Care. Apr 2011;34(4):852-4. [Medline]. [Full Text].
  9. Menchine M, Probst MA, Agy C, Bach D, Arora S. Diagnostic accuracy of venousblood gas electrolytes for identifying diabetic ketoacidosis in the emergency department. Acad Emerg Med. 20 Oct;18(10):1105-8. doi: 10.1111/j.1553-2712.2011.01158.x. Epub 2011 Sep 26. PubMed PMID: 21951652.
  10. Laffel L. Ketone bodies: a review of physiology, pathophysiology and application of monitoring to diabetes. Diabetes Metab Res Rev. 1999 Nov-Dec;15(6):412- 26. Review. PubMed PMID: 10634967.
  11. Lone SW, Siddiqui EU, Muhammed F, Atta I, Ibrahim MN, Raza J. Frequency, clinical characteristics and outcome of diabetic ketoacidosis in children with type-1 diabetes at a tertiary care hospital. J Pak Med Assoc. 2010 Sep;60(9):725-9. PubMed PMID: 21381577.
  12. Goldstein DE, Little RR, Lorenz RA, Malone JI, Nathan DM, Peterson CM. Tests of glycemia in diabetes Technical review, Diabetes Care. 1995;18(6):896-909.