ESPE Abstracts (2015) 84 P-2-485

Is Bedside Monitoring of Blood Beta-Hydroxybutyrate Levels Reliable in the Management of Hypoglycaemia in Children?

Supriya Phanse, Catherine Collingwood, Hussain Alsaffar, Mohammed Didi & Senthil Senniappan


Alder Hey children’s Hospital, Liverpool, UK


Background: Bedside blood ketone measurement has often been used in the management of diabetic ketoacidosis. However there is no available data on its reliability in the evaluation of hypoglycaemia in children. We aimed to assess the reliability of bedside ketones (β-hydroxybutyrate, BHB) in the evaluation of hypoglycaemia in children.

Objective and hypotheses: To assess reliability of bedside ketone measurement in a clinical setting of hypoglycaemia in children.

Method: We collected data on 20 children who had paired measurements of bedside and lab BHB at the end of a controlled fast. Bedside BHB was measured by finger prick at end of the controlled fast or at the time of hypoglycemia (blood glucose <3 mmol/l) using Precision Xceed Pro blood glucose & β–ketone monitoring system (Abbott Diabetes Care, Alameda, USA). Venous sample was sent simultaneously for measurement of BHB concentration using an enzymatic method (Randox laboratories, Crumlin, UK). Bland-Altman analysis & Regression analysis were used to compare bedside BHB measurement with the established lab BHB assay.

Results: The mean age was 3.8 years (M:F=14:6). Out of 20 children, 6 with CHI (congenital hyperinsulinism) underwent fast to assess fast tolerance on treatment, 6 underwent fast when they came off diazoxide therapy for CHI and 8 underwent diagnostic fast for recurrent hypoglycaemia, which was subsequently confirmed as ketotic hypoglycaemia. Both bedside and measurements showed good correlation on regression analysis [r=0.98 (P<0.01)]. Using Bland-Altman analysis, mean difference between the two assays was noted to be minimal [0.11 (SEM ±0.107)].

Conclusion: In this study, we have demonstrated that assessment of bedside ketones using Precision Xceed Pro system is a reliable way of evaluating ketotic response during hypoglycaemia in children. Bedside ketone measurement is a simple tool that would provide valuable insight into the aetiology of hypoglycaemia.

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