The role of point-of-care blood testing for ketones in the diagnosis of diabetic ketoacidosis

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dc.contributor.authorCoetzee, Ankiaen_ZA
dc.contributor.authorHoffmann, Marizaen_ZA
dc.contributor.authorAscott-Evans, Brynneen_ZA
dc.date.accessioned2016-08-10T12:08:21Z
dc.date.available2016-08-10T12:08:21Z
dc.date.issued2015
dc.descriptionCITATION:Coetzee, A., Hoffmann, M. & Ascott-Evans, B. 2015. The role of point-of-care blood testing for ketones in the diagnosis of diabetic ketoacidosis. South African Medical Journal, 105(9):756-759, doi:10.7196/SAMJnew.7889.
dc.descriptionThe original publication is available at http://www.samj.org.za
dc.description.abstractBackground. Urine dipstick testing for ketones is widely used when diabetic ketoacidosis (DKA) is suspected in patients with hyperglycaemia. If urinary ketones are positive, patients are referred for further management – often inappropriately, as the test is a poor surrogate for plasma ketones. Plasma beta-hydroxybutyrate (β-OHB) levels >3 mmol/L are diagnostic of DKA, while levels <1 mmol/L are insignificant. Objectives. To evaluate a hand-held electrochemical (point-of-care testing; POCT) ketone monitor and compare it with the gold-standard manual enzymatic method (MEM) for detection of plasma ketones. Methods. In a prospective and comparative study, we evaluated the measurement of β-OHB by means of POCT and the MEM in 61 consecutive samples from patients with suspected DKA at Tygerberg and Karl Bremer hospitals, Cape Town, South Africa. Capillary (for POCT) and plasma samples (for the MEM) were obtained simultaneously and compared for accuracy. Precision was assessed with control samples. Results. The POCT method was precise (coefficient of variation <4.5%), and there was a good correlation between the two methods (r=0.95). Regression analysis showed a proportional bias, with POCT reading higher than the MEM. However, when assessed at the relevant medical decision limits (β-OHB >3 mmol/L and <1 mmol/L), the total allowable error (bias + imprecision) was not exceeded. Patients will therefore still be classified correctly. The POCT method had a sensitivity of 100% and specificity of 89% for DKA (β-OHB >3 mmol/L), while at levels <1 mmol/L sensitivity was 100% and specificity 87.5%. Conclusion. The POCT device provides an accurate and precise result and can be used as an alternative to the MEM in the diagnosis of DKA.en_ZA
dc.description.abstractAFRIKAANSE OPSOMMING: Geen opsomming beskikbaaraf_ZA
dc.description.urihttp://www.samj.org.za/index.php/samj/article/view/8969
dc.description.versionPublisher's version
dc.format.extent4 pagesen_ZA
dc.identifier.citationCoetzee, A., Hoffmann, M. & Ascott-Evans, B. 2015. The role of point-of-care blood testing for ketones in the diagnosis of diabetic ketoacidosis. South African Medical Journal, 105(9):756-759, doi:10.7196/SAMJnew.7889
dc.identifier.issn2078-5135 (online)
dc.identifier.issn0256-9574 (print)
dc.identifier.otherdoi:10.7196/SAMJnew.7889
dc.identifier.urihttp://hdl.handle.net/10019.1/99352
dc.language.isoen_ZAen_ZA
dc.publisherHealth and Medical Publishing Groupen_ZA
dc.rights.holderHealth & Medical Publishing Groupen_ZA
dc.subjectKetones -- Testingen_ZA
dc.subjectKetoacidosisen_ZA
dc.subjectDiabetes -- Complicationsen_ZA
dc.subjectDiabeticsen_ZA
dc.titleThe role of point-of-care blood testing for ketones in the diagnosis of diabetic ketoacidosisen_ZA
dc.typeArticleen_ZA
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