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Point-of-care blood ketone testing: screening for diabetic ketoacidosis at the emergency department Charles RA; Bee YM; Eng PH; Goh SYSingapore Med J 2007[Nov]; 48 (11): 986-9INTRODUCTION: We piloted the use of a blood beta-hydroxybutyrate meter as a point-of-care testing in an emergency department (ED) to establish its role in distinguishing ketosis/ketoacidosis from simple hyperglycaemia, and develop guidelines for its use in the ED. METHODS: 111 consecutive patients presenting with capillary glucose levels exceeding 14 mmol/L had a simultaneous blood ketone measurement at triage. This was correlated with clinical diagnosis, venous bicarbonate levels and urine ketone testing. RESULTS: The median beta-hydroxybutyrate levels was 5.7 (range 4.3-6.0) mmol/L for patients with diabetic ketoacidosis (DKA) and 0.1 (0.0-3.2) mmol/L for the remaining patients. Only 47.7 percent could provide urine samples in the ED. A blood ketone result of 3.5 mmol/L yielded 100 percent specificity and sensitivity for the diagnosis of DKA. CONCLUSION: This is a useful tool that allows clinicians to immediately distinguish between simple hyperglycaemia and potentially life-threatening ketotic states. We formulated simple guidelines for its utilisation in an ED setting.|*Emergency Service, Hospital[MESH]|*Mass Screening[MESH]|*Point-of-Care Systems[MESH]|3-Hydroxybutyric Acid/blood[MESH]|Adolescent[MESH]|Adult[MESH]|Aged[MESH]|Aged, 80 and over[MESH]|Bicarbonates/blood[MESH]|Blood Glucose/metabolism[MESH]|Diabetic Ketoacidosis/blood/*diagnosis[MESH]|Diagnosis, Differential[MESH]|Female[MESH]|Humans[MESH]|Hyperglycemia/blood/diagnosis[MESH]|Ketone Bodies/*blood[MESH]|Male[MESH]|Middle Aged[MESH]|Pilot Projects[MESH]|Practice Guidelines as Topic[MESH]|Predictive Value of Tests[MESH]|Singapore[MESH]|Triage[MESH] |
