Beta-hydroxbutyrate

What is Beta-hydroxybutyrate?

BHB is the best indicator of DKA:

  • BHB is 1 of 3 sources of ketone bodies.
  • Its relative proportion in the blood (78%) is greater than the other 2 ketone bodies, acetoacetate (20%) and acetone (2%).
  • As DKA is treated, serum BHB decreases more consistently than acetoacetate which is converted to HB and does not change as rapidly.
  • The HB/acetoacetate ratio is typically between 3:1 and 7:1 in severe ketotic states.
  • The American Diabetes Association (ADA) recommends the use of blood ketone testing, based on the measurement of BHB, rather than urine ketone testing, for the diagnosis and monitoring of DKA.

BHB Results are Quantitative

Quantitative results

Provides physicians with meaningful quantitative results to better differentiate metabolic acidosis and helps in monitoring therapy.

Expected Values

Normal levels are expected to be less than 0.6 mmol/L. Results between 0.6 and 1.5 mmol/L may require medical assistance. Results higher than 1.5 mmol/L indicate the patient may be at risk of DKA.

Earlier resolution during insulin therapy

BHB levels have been shown to decrease long before acetoacetate & acetone levels, thus providing a better predictor of DKA resolution.

Can be useful in differential diagnosis of HHS in type 2 diabetes

BHB values are crucial because Hyperglycemic Hyperosmolar Syndrome (HHS) presents without significant ketoacidosis.