PD. Lohano, M. Ibrahim, SJ. Raza, M. Gowa and SH. Baloch (2022). Comparing Finger-stick Βeta-hydroxybutyrate with Dipstick Urine Tests in the Detection of Ketone Bodies in the Diagnosis of Children with Diabetic Ketoacidosis. Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 32(4), 483-486. https://doi.org/10.29271/jcpsp.2022.04.483

PubMed 35330522

[Abstract]
OBJECTIVE: To compare the finger-stick β-hydroxybutyrate (β-OHB) method accuracy with dipstick urine test for the detection of ketone bodies to diagnose diabetic ketoacidosis in children.

STUDY DESIGN: Cross-sectional study.

PLACE AND DURATION OF STUDY: Department of Pediatrics, National Institute of Child Health, Karachi, from March to August 2021.

METHODOLOGY: Ninety-six known or newly diagnosed diabetic patients aged 2-15 years with suboptimal glycemic control and diabetic ketoacidosis were included in the study. A urine dipstick test was utilised to evaluate the absence or presence of ketones in the urine. In point-of-care, blood β-OHB levels were recorded.

RESULTS: Among 96 children, with median age of 10 years (IQR=6-11), 11 (11.5%) children had traces of urine ketones, 7 (7.3%) had + urine ketones, 19 (19.8%) had ++ urine ketones, 26 (27.1%) had +++ ketones and 19 (19.8%) had ++++ ketones. In 66 patients (68.75%), capillary blood ketone was observed to be positive by a finger-stick β-OHB method. The finger-stick β-OHB method had a higher sensitivity (90.4% vs. 84.9%), specificity (100% vs. 91.3%), and accuracy (92.7% vs. 86.5%) than the dipstick urine test.

CONCLUSION: Finger-stick β-OHB method can serve as a more accurate alternative to the urinary dipstick method for the measurement of ketones and to exclude ketosis and diagnosis of diabetic ketoacidosis (DKA) in hyperglycemic children.

KEY WORDS: Diabetes mellitus, Hyperglycemia, Diabetic ketoacidosis, Point-of-care testing, Ketosis, Urine ketones, Acetoacetates.