Betahidroxibutirato capilar en la monitorizacion de la cetoacidosis diabetica / Capillary beta-hydroxybutyrate determination for monitoring diabetic ketoacidosis

RESUMEN

Fundamento y objetivo La cetoacidosis diabetica (CAD) es la complicacion aguda mas grave de la diabetes mellitus tipo 1. Su tratamiento con insulina viene guiado por los valores obtenidos en las determinaciones de glucemia y los cambios gasometricos, mientras que los niveles de beta-hidroxibutirato (BHB) raramente son determinados. El objetivo del estudio fue evaluar la utilidad de la monitorizacion de BHB capilar en el curso y resolucion de una CAD. Pacientes y metodos Se estudiaron 30 pacientes diabeticos tipo 1 con CAD a los que se les aplica un protocolo estandar, con monitorizacion de glucosa y gasometria venosas, cetonuria semicuantitativa y BHB capilar. Para el seguimiento se establecieron a priori tres grupos de acuerdo con el tiempo de recuperacion segun criterios bioquimicos (grupo 1 < 24h; grupo 2 24-48h; grupo 3 > 48h) y se correlacionaron las (..)(AU)

ABSTRACT

Background and objective: Diabetic ketoacidosis (DKA) is the most severe acute metaboliccomplication of type 1 diabetes mellitus. Insulin treatment is commonly guided by plasmaglucose levels and changes in venous blood gases, while -hydroxibutyrate (BHB) levels arerarely measured. The study objective was to evaluate the value of capillary BHB monitoring inthe course and resolution of DKA.Patients and methods: Thirty patients with type 1 diabetes admitted for DKA were enrolled. Astandard protocol including monitoring of blood glucose, venous blood gases, semiquantitativeketonuria, and capillary BHB was used. Patients were divided into three groups by time to DKAresolution (group 1 < 24 h, group 2 24-48 h, group 3 >48 h), and BHB results were compared toall other biochemical measurements.Results: Mean laboratory results upon admission were blood glucose 415 (standard deviation[SD] 106) mg/dL; bicarbonate 9.6 (SD 1.5) mmol/L; pH 7.13 (SD 0.04); BHB 4.33 (SD 0.48)mmol/L, and ketonuria 3+ in 22 patients and 4+ in 6. BHB correlated well with bicarbonate(r = -0.24139; P = 0.0161) and pH (r = -0.56419; P < 0.0001). BHB normalized earlier than ketonuriain all cases (group 1 15.5 vs 18.8 hours P < 0.05; group 2 18.2 vs 23.5 hours P < 0.01; group3 37.3 vs 41.7 hours P < 0.01). Ten percent of patients still had ketonuria when blood ketonelevels were already normal (<0.5 mmol/L).Conclusion: BHB measurement is an easy, practical, and reliable monitoring method in DKA andmay be used as a parameter to adjust insulin treatment (AU)