Serum β-hydroxybutyrate measurement in patients with uncontrolled diabetes mellitus

Objective: To assess whether routinely measuring serum beta-hydroxybutyrate (beta-OHB) concentration might help judge the severity of or assist in treating patients with suspected ketoacidosis. Methods: Serum beta-OHB level was estimated by a standard enzymatic method in 64 episodes in adults admitted to a municipal hospital. Of the 85 specimens analyzed, 60 were taken before treatment from a nearly consecutive group of diabetic patients with ketosis, 21 were follow-up specimens, and 4 were from nondiabetic patients with ketosis. Results: In the 85 specimens, the correlation between serum carbon dioxide and beta-OHB levels was -0.69, and that between anion gap and beta-OHB level was 0.75. For just the initial specimens, the respective correlation coefficients were -0.60 and 0.52. Conclusions: The correlations between serum beta-OHB and carbon dioxide levels and the anion gap were close, but not sufficiently so for the beta-OHB measurements to be routinely useful alone to assess the severity of the ketoacidosis. Full laboratory assessment of the severity and characteristics of ketoacidosis also requires knowledge of serum carbon dioxide level, anion gap, often blood pH, and ideally serum acetoacetate and lactate concentrations as well as serum beta-OHB concentration.