NEW YORK (Reuters Health) -– A point-of-care test for beta-hydroxybutyrate in capillary blood is more specific than a urine dipstick for ketones in identifying diabetic ketoacidosis in emergency-department patients, researchers report in Diabetes Care online February 9.

The beta-OHB test could therefore cut down the number of unnecessary work-ups for DKA among hyperglycemic patients seen in the emergency department, suggest Dr. Sanjay Arora and colleagues at the University of Southern California, Los Angeles.

The team compared results of a urine dipstick for ketones (Siemens Multistix 10SG) with a point-of-care capillary beta-OHB measurement (Precision Xtra meter; Medisense/Abbott Laboratories) in 516 patients with a triage capillary blood glucose level of at least 250 mg/dL.

DKA was confirmed by blood chemistries in 54 of the patients. “The sensitivity of capillary beta-OHB and the urine dipstick for DKA were identical at 98.1%,” the investigators found. However, the specificity of beta-OHB was more than twice as high as that of the urine dipstick (78.6% vs. 35.1%; p<0.01). Consequently, while the negative predictive value of both tests was more than 99%, the positive predictive values differed substantially: 34.9% for capillary beta-OHB compared with 15.0% for the urine dipstick. Dr. Arora and colleagues conclude, “Utilizing point-of-care beta-OHB testing has the potential to substantially reduce comprehensive laboratory evaluations for DKA among hyperglycemic emergency-department patients.” Reference:
Diagnostic Accuracy of Point-of-Care Testing for Diabetic Ketoacidosis at Emergency-Department Triage β-hydroxybutyrate versus the urine dipstick


Diabetes Care 2011.