"Background: diabetic ketoacidosis (DKA) is a potentially lethal complication of diabetes mellitus (DM). There is no study in Indonesia that compares the much-preferred capillary beta hydroxybutirate (β-OHB) measurement to urine acetoacetate in monitoring therapeutic response of DKA in adolescents.
Methods: a prospective study of 37 adolescents and children with DKA in Cipto Mangunkusumo Hospital was done between June 2006 and March 2011. The patients were followed until the time of DKA resolution. Hourly measurement of random blood glucose, capillary β-OHB concentration, and urine ketones were done, while blood gas analysis and electrolyte were measured every four hours.
Results: median time to resolution was 21 (9-52) hours. Compared to urine ketones, capillary β-OHB concentration showed stronger correlation with pH (r= -0,52, p= 0,003 vs r= -0,49, p= 0,005) and bicarbonate level (r=-0,60, p=0.000 vs r= -0.48, p=0.007) during the median time of DKA resolution. All capillary β-OHB measurement yielded negative results at median time of DKA resolution, while urine ketones were still detected up to 9 hours after resolution.
Conclusion: blood ketone concentration showed better correlation with pH and bicarbonate level, as a tool to monitor therapeutic response in DKA in adolescent, compared to traditional urine ketones test in adolescents.
Latar belakang: ketoasidosis Diabetes (KAD) adalah komplikasi Diabetes Melitus (DM) yang berpotensi mengakibatkan kematian. Saat ini belum ada studi di Indonesia yang membandingkan pengukuran kadar beta-hidroksibutirat (β-OHB) kapiler dengan asetoasetat pada urin untuk memonitor respon terapi dari DKA pada remaja. Metode: studi prospektif terhadap 37 remaja dan anak dengan diagnosis KAD di Rumah Sakit Dr. Cipto Mangunkusumo selama Juni 2006-Maret 2011 hingga KAD dinyatakan resolusi. Pemeriksaan gula darah sewaktu, β-OHB kapiler, dan keton urin dilakukan setiap jam, sedangkan analisis gas darah dan elektrolit dilakukan setiap empat jam. Hasil: median waktu resolusi KAD adalah 21 (9-52) jam. Saat median resolusi KAD, terdapat korelasi signifikan yang lebih baik antara kadar β-OHB kapiler dibandingkan dengan kadar keton urin terhadap pH (r= -0,52, p= 0,003 vs r= -0,49, p= 0,005) serta terhadap bikarbonat (r= -0,60, p= 0,000 vs r= -0,48, p= 0,007). Kadar β-OHB kapiler seluruhnya menunjukkan hasil negatif saat median resolusi, sedangkan ketonuria masih ditemukan hingga 9 jam paska resolusi. Kesimpulan: kadar keton darah menunjukkan korelasi yang lebih baik terhadap pH dan bikarbonat untuk menentukan respon terapi KAD pada remaja dan anak bila dibandingkan dengan metode keton urin"