Endocrine Abstracts

Background: ISPAD clinical practice consensus guidelines 2006–7 defined DKA as: blood glucose >11 mmol/l in presence of venous pH <7.3 or bicarbonate <15 mmol/l, ketonaemia and ketonuria. The level of ketonaemia or ketonuria was not specified. Blood ketones can be checked easily using a blood ketone meter (Optium). In our institution we have been measuring them on all children admitted with suspected DKA over the last 5 years. A blood ketone level of >3.0 mmol/l was considered as frank ketoacidosis.

Aim: To determine if blood ketone levels at admission correlate with traditional methods of diagnosing DKA (pH, bicarbonate and blood glucose), and whether they usefully aid the diagnosis.

Method: Retrospective data were collected on all children under the age of 16 years who were hospitalised with DKA at our institution over a 3 year period (2006–8). Admission data recorded were: blood ketone levels; venous pH; serum bicarbonate and blood glucose levels.

Results: Sixty-three episodes of DKA were scrutinised in 51 patients. Of 44/63 (70%) had ketone values >3.8. 32/44 (73%) cases corresponded to blood pH <7.3 and bicarbonate <15 mmol/l. There was no relationship between blood ketone and glucose levels (r=0.12, P=0.35); however there was a significant negative relationship between blood ketones and pH (r=−0.425, P=0.001) and between blood ketones and serum bicarbonate (r=−0.594, P<0.001) which indicates that the higher the blood ketones, the lower the pH and bicarbonate levels.

Conclusions: Blood ketone levels may be a useful tool to aid the diagnosis of DKA. Ketone levels >3.8 should prompt urgent medical assessment. Further large prospective studies are required to assess the reliability of the correlation between ketonaemia and acidosis.