Point-of-care blood ketone testing: screening for diabetic ketoacidosis at the emergency department

Singapore Med J. 2007 Nov;48(11):986-9.


Introduction: We piloted the use of a blood beta-hydroxybutyrate meter as a point-of-care testing in an emergency department (ED) to establish its role in distinguishing ketosis/ketoacidosis from simple hyperglycaemia, and develop guidelines for its use in the ED.

Methods: 111 consecutive patients presenting with capillary glucose levels exceeding 14 mmol/L had a simultaneous blood ketone measurement at triage. This was correlated with clinical diagnosis, venous bicarbonate levels and urine ketone testing.

Results: The median beta-hydroxybutyrate levels was 5.7 (range 4.3-6.0) mmol/L for patients with diabetic ketoacidosis (DKA) and 0.1 (0.0-3.2) mmol/L for the remaining patients. Only 47.7 percent could provide urine samples in the ED. A blood ketone result of 3.5 mmol/L yielded 100 percent specificity and sensitivity for the diagnosis of DKA.

Conclusion: This is a useful tool that allows clinicians to immediately distinguish between simple hyperglycaemia and potentially life-threatening ketotic states. We formulated simple guidelines for its utilisation in an ED setting.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • 3-Hydroxybutyric Acid / blood
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Bicarbonates / blood
  • Blood Glucose / metabolism
  • Diabetic Ketoacidosis / blood
  • Diabetic Ketoacidosis / diagnosis*
  • Diagnosis, Differential
  • Emergency Service, Hospital*
  • Female
  • Humans
  • Hyperglycemia / blood
  • Hyperglycemia / diagnosis
  • Ketone Bodies / blood*
  • Male
  • Mass Screening*
  • Middle Aged
  • Pilot Projects
  • Point-of-Care Systems*
  • Practice Guidelines as Topic
  • Predictive Value of Tests
  • Singapore
  • Triage


  • Bicarbonates
  • Blood Glucose
  • Ketone Bodies
  • 3-Hydroxybutyric Acid