When the body does not have a sufficient amount of glucose available to meet its demand for energy, the body begins to utilize its stored fat for energy.
These fats are metabolized in the liver and this metabolism produces chemical byproducts called ketones.
Under normal circumstances, ketones are broken down into carbon dioxide and water by the liver and other organs.
If the buildup of ketones continues unchecked, this condition can prove fatal a condition known as acidosis.
These ketone bodies consist of acetone, acetoacetate, and ß-Hydroxybutyrate.
The detection of ketosis is important in several clinical conditions. The most important is the detection of potentially fatal ketoacidosis in diabetics.
Patients with Type 1 diabetes are prone to developing ketoacidosis – an excessive buildup of ketones in the blood due to accelerated ketone synthesis and the body’s limited capacity to break them down.1
Measuring the level of ketones is clinically useful in not only diagnosing Diabetic Ketoacidosis (DKA), but also in monitoring the results of treatment.
Measuring ketone bodies, specifically BHB, along with other lab tests (such as glucose, pH, anion gap, bicarbonate) is useful in confirming a clinical suspicion of ketoacidosis. Additionally, because BHB is quantitative it can be used to monitor the patient during treatment for ketoacidosis.
The American Diabetes Association Clinical Practice Recommendations state that under the following conditions, diabetics should be tested for the presence of ketones:
|Other conditions where ketone testing is considered to be of clinical value||
Ketosis warning signs
Bad Breath, Weight Loss, Increased Ketones in the Blood, Increased Ketones in the Breath or Urine, Appetite Suppression, Digestive Issues, Insomnia...
When the body begins to break down its stored fats in response to a low supply of energy (glucose) it produces β-hydroxybutyrate, acetoacetate and acetone.
Ketones (like glucose) can be tested or monitored in either urine or blood. Many hospitals still use nitroprusside tablets for confirming ketoacidosis.
In contrast, serum ß-HB levels provide a reliable and quantitative method of diagnosing and monitoring treatment of ketoacidosis.5
Improved clinical outcomes and enhanced cost efficiency have also been reported due to blood testing of ß-Hydroxybutyrate.6
These improvements are seen in the following areas:
The ß-Hydroxybutyrate (B-HB) reagent is used to detect ketones to identify patients suffering from diabetic ketoacidosis, amongst many other clinical applications.
The nitroprusside urine method is efficient at providing a qualitative assessment of ketosis and ketoacidosis by detecting both acetoacetate and acetone; however, it does not detect ß-Hydroxybutyrate.
In addition, the nitroprusside method has demonstrated susceptibility to false positive results from drug interference and false negative results due to reagent deterioration.
The effect of fluid intake and urine concentration can significantly affect urine test results, making this method unreliable.5
CLIA waived ketone tablets to measure acetoacetic acid and acetone in urine in 30 seconds, serum in 2 minutes, plasma and whole blood in 10 minutes.
Foster DW, McGarry JD. The metabolic derangement and treatment of diabetic ketoacidosis. N Engl J Med. 1983;309(3):159-169.
Acetest® and Ketostix® are registered trademarks of Bayer Corporation, Elkhart, Indiana.
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