Test Information

Beta-Hydroxybutyrate (BOH) is the predominant ketone body in the blood.  It is the most sensitive marker for detecting ketosis.  The American Diabetes Association has recommended BOH as the preferred method for diagnosing and monitoring treatment of diabetic ketoacidosis. 

Ketone bodies are catabolic products of free fatty acids.  Beta-hydroxybutyrate accounts for 78% of ketone bodies in the blood; the other two are acetoacetate (20%) and acetone (2%).  Although ketone bodies are acidic, normal renal and respiratory functions compensate for ketogenesis and maintain acid-base homeostasis.  In ketoacidosis, these physiological mechanisms are unable to compensate for the ketone bodies produced.  The excess accumulates and the blood pH is lowered to acidic levels.

BOH is increased in alcoholic ketoacidosis, lactic acidosis (shock, renal failure), liver disease, infections, and salicylate poisoning.

BOH has been shown to allow a better management of patients with seizure reduction than urinary ketones in patients on ketogenic diet with refractory epilepsy.  Ketosis in urine only indicates compliance but not of value in terms of efficacy.

Dipstick serum ketone determination using nitroprusside reagent is often used to estimate ketone body status, but that method has inherent problems.  The dipstick does not measure beta-hydroxybutyrate, the most abundant if the physiological ketone bodies; the nitroprusside reagent only reacts with acetoacetate and acetone.

Although BOH performed on Stanbio meter method correlates well to the Stanbio liquid method, results are not directly comparable.  Individual results show significant biases acrosss methodologies.  Results should not be intermixed when serially tracking a patient.