Capillary versus Serum b-hydroxybutyrate in Pediatric Diabetic Ketoacidosis

ABSTRACT

Objective:To find the strength of agreement between point-of-care and serum β-hydroxybutyrate. Methods: 236 paired samples (capillary β-hydroxybutyrate by a point ofcare device and serum β-hydroxybutyrate by colorimetric enzymatic estimation) sampleswere collected from 26 children aged <13 years admitted with diabetic ketoacidosis. Inbornerrors of metabolism and septic shock were excluded. Results: Capillary β-hydroxybutyrateshowed excellent agreement with serum â-hydroxybutyrate with mean (SD) bias of 0.027(0.78); 95% limit of agreement -1.51, 1.56 and intraclass correlation 96.1% (95%CI 95%–97%, P<0.001). An increase in the bias noted for value above 5 mmol/L (P<0.001) (serummeasurements were higher than capillary point-of-care measure-ments). Capillary â-hydroxybutyrate correlated significantly with blood pH, anion gap,bicarbonate and carbondioxide levels on blood gas analysis (P<0.05). Conclusions: Capillary β-hydroxybutyrateestimation is a valid method for monitoring of ketonemia in pediatric diabetic ketoacidosis