Endocrine Abstracts

Introduction: Bedside blood ketone measurement has often been used in the management of diabetic ketoacidosis. However there is no available data on its reliability in the evaluation of hypoglycaemia in children. We aimed to assess the reliability of bedside ketones (beta-hydroxybutyrate (BHB)) in the evaluation of hypoglycaemia in children.

Methods: We collected data on 20 children who had paired measurement of bedside and lab BHB at the end of a controlled fast. Bedside BHB was measured by finger prick at end of the controlled fast or at the time of hypoglycemia (blood glucose <3 mmol/l) using Precision Xceed Pro blood glucose and β-ketone monitoring system (Abbott Diabetes Care, Alameda, USA).Venous sample was sent simultaneously for measurement of BHB concentration using an enzymatic method (Randox laboratories, Crumlin, UK). Bland–Altman analysis and Regression analysis were used to compare bedside BHB measurement with the established lab BHB assay.

Results: The mean age was 3.8 years (M:F=14:6). Out of the 20 children, six children with CHI underwent fast to assess fast tolerance on treatment, six CHI children underwent fast when they came off diazoxide therapy and eight children underwent diagnostic fast for recurrent hypoglycaemia, which was subsequently confirmed as ketotic hypoglycaemia. Both the measurements showed a good correlation on regression analysis (r=0.98, P<0.01). Using Bland–Altman analysis, the mean difference between the two assays was noted be minimal (0.11 (S.E.M. ±0.107)).

Conclusion: In this study, we have demonstrated that assessment of bedside ketones using Precision Xceed Pro system is a reliable way of evaluating the ketotic response during hypoglycaemia in children. Bedside ketone measurement is a simple tool that would provide valuable insight into the aetiology of hypoglycaemia.