Clinical utility of beta-hydroxybutyrate measurement in the management of physiological ketosis at home in children under 5

Clinical utility of beta-hydroxybutyrate measurement in the management of physiological ketosis at home in children under 5

Authors

  • Maurizio Vanelli University Center for Health systems organization, quality and sustainability, University of Parma, Parma, Italy
  • Carla Mastrorilli Pediatric and Neonatology Unit, Madonna delle Grazie Hospital - ASM Matera, Matera, Italy
  • Valentina Fainardi Research Doctorate in Medical Science, University of Parma, Parma, Italy
  • Brunella Iovane Postgraduate School of Pediatrics, University of Parma, Parma, Italy
  • Chiara Scarabello Postgraduate School of Pediatrics, University of Parma, Parma, Italy
  • Piero Veronese Postgraduate School of Pediatrics, University of Parma, Parma, Italy
  • Umberto Fanelli Postgraduate School of Pediatrics, University of Parma, Parma, Italy
  • Tiziana Incerti Postgraduate School of Pediatrics, University of Parma, Parma, Italy
  • Bertrand Tchana Postgraduate School of Pediatrics, University of Parma, Parma, Italy
  • Icilio Dodi Postgraduate School of Pediatrics, University of Parma, Parma, Italy
  • Dora Di Mauro Postgraduate School of Pediatrics, University of Parma, Parma, Italy

Keywords:

Key words: ketone bodies, physiological ketosis, 3-beta-hydroxybutyrate, ketonemia, ketonuria

Abstract

Aim: To verify the possible advantages of 3- β-hydroxybutyrate (3HB) measurement compared to urinary assay of ketones during an intercurrent disease managed at home. Methods: Twelve Pediatricians were asked to enroll at least 4 patients aged 3 to 5 years, affected by an intercurrent illness and showing at least one of symptoms reliable to ketosis. Recruited patients were submitted to the simultaneous assay of 3HB in capillary blood and ketones in urine at 3 (T3) and 6 hours (T6) from the first measurement (T0). For urinary and blood ketone detection commercial tests were used. Results: Thirty-eight children (4.36±2.60 years old; 25 boys) were enrolled into the study. At T0 all children showed 3HB levels (1.2-3.2 mmol/L), but only 10 of them (26.3%) associated also urinary ketone bodies (2 to 4+). In response to 3 hour treatment (T3) with a glucose solution, 3HB values decreased in 19 (0,8-1,8 mmol/L) and normalized in 13 children (<0.2 mmol/L); while ketonuria disappeared in only 2 patients, it was confirmed in 8 and appeared (4+) the first time in the remaining 28 children. At T6 3HB levels fell definitively within the normal range in all children, while ketonuria was still present (2+) in 9 patients (23%). The pediatricians reported two limitations about blood 3HB dosage compared to the urinary test: the invasiveness of capillary blood collection, and the cost of supplies for finger pricking, reagent strips and reflectance meter. Conclusions. 3HB monitor in capillary blood is more effective and clinically more useful in diagnosing and managing of an ongoing ketosis in children with a mild infective disease than ketones detection in the urine. These advantages are mitigated by the cost of 3HB measurement.

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Published

23-05-2019

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ORIGINAL ARTICLES

How to Cite

1.
Clinical utility of beta-hydroxybutyrate measurement in the management of physiological ketosis at home in children under 5. Acta Biomed [Internet]. 2019 May 23 [cited 2024 Apr. 18];90(2):215-20. Available from: https://mattioli1885journals.com/index.php/actabiomedica/article/view/8260

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