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Item Value
Approval req'd? No
Available Stat? Yes
Test code BHOB
Test group Ketones
Performed by Parnassus & Mission Bay Chemistry
In House Availability Test available 24 hours per day 7 days per week
Method Stanbio enzymatic (D-3-hydroxybutyrate dehydrogenase)
Container type Gold top or Light Green top
Amount to Collect 2 mL blood
Sample type Serum or plasma
Preferred volume 1 mL
Min. Volume 0.5 mL
Units mmol/L
Normal range 0.02 - 0.27 mmol/L
Synonyms Ketones
Stability Refrigerated 1 week
Additional information Beta-hydroxybutyrate (b-OHB) is produced from beta-fatty acid metabolism in patients suffering starvation, acute alcohol use, or in diabetic ketoacidosis. Beta-hydroxybutyrate normally accounts for 50 - 75% of the ketone bodies released into blood, with acetoacetic acid and acetone accounting for the remainder.

During extended fasting or diabetic ketoacidosis, the ratio of beta-hydroxybutyrate to acetoacetic acid is usually around 2 or 3 but can vary between 1 and 6 depending on redox state (Porter et al., Am J Clin Path 1997; 107:353-358).

Under usual circumstances, b-OHB concentrations do not exceed 1 mmol/l in type 1 diabetic subjects. In patients presenting with DKA, the mean b-OHB typically ranges between 4 and 12 mmol/l (Wallace and Matthews,. Q J Med 2004; 97:773–780).

This test may be more specific for diabetic ketoacidosis than the Acetest tablet testing for acetoacetic acid/acetone or the Ketostix dipstick test on urinalysis which primarily reacts with acetoacetic acid. In hyperglycemic patients in the emergency department, urine dipsticks may have similar sensitivity as measurements of b-OHB in blood for detecting diabetic ketoacidosis (DKA) (Arora et al, Diabetes Care 2011, 34:852-4).

Frequent monitoring of serum ketones in uncomplicated DKA may add little additional clinical information over measurements of serum glucose and total carbon dioxide (Porter et al., Am J Clin Path 1997; 107:353-358).

Reference range adapted from studies by the assay manufacturer in healthy adults fasted for 12 hours before blood collection and verified by in house testing of 22 samples from normal volunteers.
CPT coding 80210
LDT or Mod FDA? No
Last Updated 1/28/2015 3:45:04 PM
Entry Number 1421
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