Bedside monitoring of blood beta-hydroxybutyrate levels in the management of diabetic ketoacidosis in children.
Bedside monitoring of blood beta-hydroxybutyrate levels in the management of diabetic ketoacidosis in children.
复制标题
DOI：
10.1089/dia.2006.8.671
复制
发表时间：
2006-11
影响因子：
5.4
通讯作者：
A. Rewers;K. Mcfann;H. Chase
中科院分区：
文献类型：
--
作者：
A. Rewers;K. Mcfann;H. Chase
前言：糖尿病酮症酸中毒(DKA)影响许多1型糖尿病儿童。DKA的胰岛素治疗传统上是通过血糖水平和血气的变化来指导的，而引起酸中毒的主要酮酸--β-羟丁酸酯(β-OHB)--很少被测量。这项研究的目的是评估床边监测血液β-OHB水平是否可以通过消除多余的实验室监测来简化DKA的管理。方法对68例DKA患儿采用常规治疗方案，监测静脉血pH、二氧化碳分压(PCO(2))、碳酸氢盐、血糖、尿素氮、电解质(每例监测2~10个时间点)。静脉β-OHb水平使用Precision Xtra仪器(MediSense/雅培糖尿病护理，伊利诺伊州雅培公园)测量，并在复制的批次血清样本上使用参考实验室方法(Cobas Mira Plus；Roche Diagnostics，印第安纳波利斯，IN)。床边血糖仪β-OHB与其他参数的相关性通过一系列一般线性模型进行评估，其时间序列的协方差结构符合空间幂定律。结果治疗期间床边血糖仪β-OHb水平与pH(r=-0.63；P<；0.0001)、碳酸氢盐(r=-0.74；P<；0.0001)、PCO(2)(r=-0.55；P<；0.0001)呈显著正相关(未调整的皮尔逊相关系数)。PH值、碳酸氢盐和PCO(2)进入了单独的时间序列分析模型，处理时间作为时间的衡量标准。结果证实，床边的β-OHB水平与静脉血pH、碳酸氢盐和PCO(2)的时间依赖水平密切相关。Bland-Altman曲线图分析证实，两种β-羟基丁酸测定方法之间有很好的一致性(r=0.92P<；0.0001)。结论Precision Xtra能准确测量血液中的β-OHb水平，特别是在较低水平。虽然pH和/或重碳酸盐的初始测量是有必要的，但在DKA的管理中，实时的β-OHB水平可以取代对这些参数的重复实验室测量。未来的研究应该评估这种简化的DKA治疗方案的安全性和成本效益。
INTRODUCTION Diabetic ketoacidosis (DKA) affects many children with type 1 diabetes. Insulin treatment of DKA is traditionally guided by changes in the blood glucose levels and blood gases, whereas beta-hydroxybutyrate (beta-OHB)--the main ketoacid causing acidosis--is rarely measured. The purpose of this study was to evaluate if bedside monitoring of blood beta-OHB levels can simplify management of DKA through elimination of superfluous laboratory monitoring. METHODS Our emergency department treated 68 children with DKA using a standard protocol with monitoring of venous pH, partial pressure of CO(2) (pCO(2)), bicarbonate, glucose, blood urea nitrogen, and electrolytes (two to 10 time points per patient). Venous beta-OHB levels were measured using the Precision Xtra meter (MediSense/Abbott Diabetes Care, Abbott Park, IL) and, on duplicate batched serum samples, using a reference laboratory method (Cobas Mira Plus; Roche Diagnostics, Indianapolis, IN). Correlations between bedside meter beta-OHB and other parameters were evaluated in a series of general linear models with a time series covariance structure fit using spatial power law. RESULTS The bedside meter beta-OHB levels were significantly correlated with pH (r = -0.63; P <0.0001), bicarbonate (r = -0.74; P <0.0001), and pCO(2) (r = -0.55; P <0.0001) at all points of measurement during the treatment (unadjusted Pearson correlations). The pH, bicarbonate, and pCO(2) were entered into separate time series analysis models with treatment duration as a measure of time. The results confirmed that bedside levels of beta-OHB correlated very closely with time-dependent levels of venous pH, bicarbonate, and pCO(2). Good agreement between the two methods of beta-OHB measurement (r = 0.92; P <0.0001) was confirmed using the Bland-Altman plot analysis. CONCLUSIONS The Precision Xtra accurately measures blood beta-OHB levels, particularly at lower levels. While the initial measurement of pH and/or bicarbonates is warranted, real-time beta-OHB levels may replace repeat laboratory measurement of these parameters in the management of DKA. Future studies should evaluate safety and cost-effectiveness of such simplified DKA treatment protocol.