الفهرس 
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Abstract
Diabetic ketoacidosis (DKA) is a life threatening acute complication of diabetes. Insulin treatment of DKA is traditionally guided by changes in the blood glucose levels and blood gases, whereas beta-hydroxybutyrate (beta-OHB) the main ketoacid causing acidosis is rarely measured.
The purpose of this study was to evaluate if bedside monitoring of blood beta-OHB levels can simplify management of DKA through elimination of superfluous laboratory monitoring .We piloted the use of blood betahydroxybutyrate meter as a care testing in an emergency department.
The present study included 50 children and adolescents with DKA admitted to Pediatric Hospital, Ain Shams University from May 2010 to january 2011. All patients in our study fulfilling the criteria of diabetic ketoacidosis (DKA) which are hyperglycemia (blood glucose >11 mmol/L (200 mg/dL), venous pH <7.3 or bicarbonate <15 mmol/L, ketonemia and ketonuria.
According to ISPAD 2009 guidelines, the clinical manifestations of diabetic ketoacidosis consisted of dehydration, rapid deep sighing (Kussmaul respiration), nausea, vomiting, abdominal pain, loss of consciousness, and fever only when infection is present which was consistent with our patients’ clinical presentation.results. Their mean age was 8.24 years with a range of (1.30 to 16) years. Regarding sex distribution in our study group, males were more than females in newly diagnosed cases as males represent 54.8% but females were 45.2%, on the other hand females were more than males in known diabetic cases as females were 57.9% and males were 42.1%.
The most important predisposing factor in our study for occurrence of DKA was infection as 28% of patient had fever, in which 16% of the cases had fever with gastroenteritis , followed by 8% of the cases had fever due to tonsillitis, and 6% due to urinary tract infection .
According to the severity of DKA , our study showed that 34% had severe DKA, , 40% of cases moderate DKA and 26% of cases had mild DKA cases, this means that the severity of DKA varies equally from mild to moderate or severe according to rapid diagnosis and quick management.
Cases with severe DKA showed significantly lower Glasgow coma scale (p=0.05) and higher mean platelets (p=0.02) when compared to mild and moderate DKA, other studied parameters (demographic data and laboratory parameters) were non significant according to severity of DKA.
In our study, the newly diagnosed cases presented with DKA were 62% and the known diabetics presented 38%.
As regards serum electrolytes (K, BUN, Creatinine) there were significant decrease from first to third reading (p‹0.05) with no difference after third readings (p›0.05).
As regards PH and HCO3 levels there were a significant increase from first to fourth reading (p‹0.05) with no difference between fourth and fifth readings (small sample size).
B-OHB and acetone in urine showed a significant decrease from first to fourth readings (p‹0.05) with no difference between fourth and fifth readings
In our study, cases with severe DKA showed significantly lower PH, PCO2, HCO3 as well as higher blood glucose and blood B-OHB (P‹0.0001 for all).
There was no statistical significant difference between severity of DKA as regards mean Na, K, BUN, Creatine, po2 levels (p›0.05).
In diabetic ketosis (DK) and ketoacidosis (DKA), β-OH butyrate (β-OHB) is the major ketone body accumulated in blood. Β-OHB is converted to acetoacetate and acetone which are excreted in urine.
The blood β-OHB meter (Optium, Abbott/Medisense Laboratories, Abingdon, UK) gives a quantitative measurement of β-OHB from a single five microlitre prick capillary blood sample by an electrochemical method ,which reduce the invasion caused by repeated blood analysis.
Using the capillary B-OHB meter is more timely and costly effective in comparison to the other parameters which are used in management of DKA in intensive care uint by reflecting earlier normalization of metabolic status than other tests.
The correlation between β-OHB and other laboratory parameters at different timings in our study showed that β-OHB was negatively correlated with PH (r= -0.57; P<0.0001), HCO3 (r=-0.85; P<0.0001), PCO2 (r=-0.65; P <0.0001) and positively correlated with blood glucose (r=0.57;P<0.0001) with no significant correlation with BUN (blood, urea, nitrogen) (r=-0.01; P=0.94) at all points of measurement during the treatment.This means that bedside meter B-OHB levels decreased steadily during treatment of DKA as PH and PCO2 levels increased and acidosis resolved.
We found also that this test is costly effective .As the cost per patient was variable due to the number of tests required for each case; in the ordinary lab tests, the average mean was found to be 227.2±15.6 LE while in case of new B-OHB test the cost was 57.6±6.3 LE (p<0.001).
More importantly we may say that it is timely effective more than other laboratory parameters ,as it minimizes the time of hospitalization due to early prediction of DKA and the blood B-OHB new measurement test takes 0.2 ±0.1 minutes while any single laboratory test by ordinary chemical methods takes 45± 2.3 minutes which makes a statistical significant difference ( P<0.001).