B-Hydroxybutyrate portal

What is Diabetic Ketoacidosis (DKA)?

Diabetic ketoacidosis is a problem that occurs in people with diabetes. It occurs when the body cannot use sugar (glucose) as a fuel source because there is no insulin or not enough insulin, and fat is used for fuel instead.

Key symptoms can include:

  • Rapid and deep breathing
  • Dry skin and mouth
  • Flushed face
  • Fruity smelling breath
  • Nausea and vomiting
  • Stomach pain

Other symptoms include:

  • Abdominal pain
  • Breathing difficulty while lying down
  • Decreased appetite
  • Decreased consciousness
  • Dulled senses that may worsen to a coma
  • Fatigue
  • Frequent urination or thirst that lasts for a day or more
  • Headache
  • Muscle stiffness or aches
  • Shortness of breath
diabetic ketoacidosis illustration

People with type 1 diabetes may be at risk when they do not have enough insulin, a hormone the body uses to break down sugar (glucose) in the blood for energy. When the body senses glucose is not available, fat is broken down instead. As fats are broken down, acids called ketones build up in the blood and urine. Ketones are poisonous in high levels and this condition is called ketoacidosis.

Blood glucose levels rise (usually higher than 300 mg/dL) because the liver makes glucose to try to combat the problem. However the cells cannot pull in that glucose without insulin.

Diabetic ketoacidosis may be the first sign of type 1 diabetes in people who do not yet have other symptoms. It can also occur in someone who has already been diagnosed with type 1 diabetes. Infection, injury, a serious illness, or surgery can lead to diabetic ketoacidosis in people with type 1 diabetes. Ketoacidosis can also occur in people with diabetes when they miss their insulin treatments.

People with type 2 diabetes can develop ketoacidosis, but it is rare. It is usually triggered by a severe illness. Hispanic and African-American people are more likely to have ketoacidosis as a complication of type 2 diabetes.

What is Beta-Hydroxybutyrate (BHB)?

During ketosis, Beta-Hydroxybutyrate (BHB) levels may increase more than levels of acetone and acetoacetate, clearly indicating the patient’s trend in metabolic status.

BHB demonstrates excellent stability, making it an excellent indicator of clinically relevant ketosis and ketoacidosis.

BHB is the main ketone body produced during ketosis. The pie chart shows a typical example of the keytone bodies of someone with severe DKA.

  • ß-Hydroxybutyrate 78%
  • Acetoacetate 20%
  • Acetone 2%

The Stanbio Chemistry Beta-Hydroxybutyrate LiquiColor® Reagent

β-Hydroxybutyrate LiquiColor® Assay (BHB)

See our BHB product page for more detailed information of the reagent, controls and calibrators.

The Stanbio Chemistry LiquiColor® BHB reagent is an enzymatic assay used by many healthcare systems in the United States.

BHB may be run on most chemistry analyzer systems with an open channel capability.

Key Features and Benefits:

  • Quantitative results
  • Enzymatic test
  • Excellent sensitivity and precision
  • Can be automated on a chemistry analyzer
  • Uses serum or plasma
  • Liquid, ready to use reagents

BHB Frequently Asked Questions

The Stanbio LiquiColor® BHB test can be used to determine the presence and levels of BHB, the predominant ketone body produced during ketoacidosis.

When the body breaks down fats in response to a low supply of energy (glucose) it produces three ketone bodies; Acetone, Acetoacetate and BHB.

Ketones (Acetone and Acetoacetate) can be tested or monitored in either urine or blood. Many hospitals still use the nitroprusside test for detecting and monitoring ketosis and ketoacidosis.

This nitroprusside urine and serum method produces a qualitative assessment of ketosis by detecting the ketones acetoacetate and acetone — it does not detect BHB.

This is significant because:

  • BHB is not a ketone, it is a hydroxyacid.
  • BHB demonstrates excellent stability, making it the most reliable indicator of clinically relevant ketosis and ketoacidosis.
  • During ketosis, BHB levels increase more than levels of acetone and acetoacetate, clearly indicating the patients trend in metabolic status.
  • Quantitative, objective results provide a better tool for differentiating metabolic acidosis and monitoring therapy.

Physicians use ketone body determinations in emergent or urgent medical situations such as diabetic ketoacidosis. Hospitals regularly measure ketone bodies using spectrophotometric methods. Note that the urine dip stick method for acetoacetate does not detect β-hydroxybutyric acid. Rapid measurements using urine dip sticks in hospitals may not be as accurate and may require confirmation by a reference lab.

  • Ability to detect and quantify BHB
  • The LiquiColor BHB test is specific for BHB, it does not react with the other ‘ketones’ in the sample
  • The LiquiColor BHB test is quantitative, so it can be used to for diagnosis and monitoring (trend) of the patient’s status
  • The LiquiColor BHB can be automated as an open channel test on most chemistry analyzers

Supporting Information

Title: BHB – Uses in the ICU Especially in the Setting of DKA

Presented by: Mark. H Oltermann MD

Location: JPS Physician Group, John Peter Smith Hospital, Fort Worth, Texas

Title: The Value Efficacy and Efficiency of β-Hydroxybutyrate

Presented by: James. H Nichols, PhD, DABCC, FACB

Location: The 2012 Clinical Lab Expo in Los Angeles

Title: Metabolic Disturbances that Lead to B-hydroxybutyrate and Ketone Bodies

Presented by: James. H Nichols, PhD, DABCC, FACB

Location: Pathology Grand Rounds at mid-west medical school

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