Clinical conditions associated with urinary excretion of 2-hydroxybutyric acid

Scand J Clin Lab Invest. 1975 May;35(3):259-66.


Urine and blood samples from patients with different clinical disorders were examined for 2-hydroxybutyric acid (2-HB) by gas chromatography and mass spectrometry. All patients with combined lactic acidosis and ketoacidosis excreted 2-HB in the urine, in amounts up to 2.3 mmol/mmol creatinine. In blood from these patients, 2-HB was present only in trace amounts. Hard physical exercise resulted in lactic acidosis and accumulation of 2-HB. The lactate to pyruvate ratio in blood and urine was markedly increased in the patients excreting 2-HB but was normal in two patients with lactic acidosis who did not excrete 2-HB. It is concluded that an increased NADH2/NAD ratio is the most important factor for the production of 2-HB.

MeSH terms

  • Acidosis / blood
  • Acidosis / urine*
  • Adult
  • Child
  • Child, Preschool
  • Creatinine / urine
  • Female
  • Humans
  • Hydroxybutyrates / blood
  • Hydroxybutyrates / urine*
  • Infant
  • Infant, Newborn
  • Ketosis / blood
  • Ketosis / urine*
  • Lactates / blood
  • Lactates / urine
  • Male
  • NAD / metabolism
  • Pyruvates / blood
  • Pyruvates / urine
  • Time Factors


  • Hydroxybutyrates
  • Lactates
  • Pyruvates
  • NAD
  • Creatinine