Use of beta-hydroxybutyric acid levels in the emergency department

Am J Ther. 1998 May;5(3):159-63. doi: 10.1097/00045391-199805000-00006.


The impact of a new test on the market, the beta-hydroxybutyric acid (BOH) assay, on clinical decision-making in the emergency department (ED) has not been well studied. In this retrospective analysis, we studied the potential benefit of this new test in the ED decision-making process in diabetic patients. BOH levels were measured on all patients who had glucose and acetone levels ordered by the emergency physician during a 3-month period in the ED of a university tertiary referral center. Two groups were analyzed: group 1 was acetone-positive and BOH-positive (n = 13); group 2 was acetone-negative BOH-positive (n = 31). There was no difference between the two groups in terms of gender (p = 0.55) or age (p = 0. 47). The length of stay (p = 0.97) and number of complications (p = 0.89) were also similar between the two groups.

Conclusion: This study suggests that in those diabetic patients with a negative acetone test and a positive BOH test, the addition of the positive result on the BOH test may provide additional prognostic information for predicting hospital length of stay and number of in-hospital complications.

MeSH terms

  • 3-Hydroxybutyric Acid / blood*
  • Acetone / blood
  • Blood Glucose / analysis
  • Diabetic Ketoacidosis / blood*
  • Diabetic Ketoacidosis / complications
  • Diabetic Ketoacidosis / drug therapy
  • Emergency Treatment / methods*
  • Fatty Acids, Nonesterified / metabolism
  • Female
  • Humans
  • Length of Stay / statistics & numerical data
  • Liver / metabolism
  • Male
  • Middle Aged
  • Prognosis
  • Reproducibility of Results
  • Retrospective Studies
  • Sensitivity and Specificity
  • Severity of Illness Index


  • Blood Glucose
  • Fatty Acids, Nonesterified
  • Acetone
  • 3-Hydroxybutyric Acid