{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T21:15:40Z","timestamp":1788383740040,"version":"build-2803163510"},"reference-count":33,"publisher":"American Diabetes Association","issue":"2","license":[{"start":{"date-parts":[[2022,1,17]],"date-time":"2022-01-17T00:00:00Z","timestamp":1642377600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.diabetesjournals.org\/content\/license"}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,2,1]]},"abstract":"<jats:p>The measurement of blood ketones in preference to urine ketones has become a well-established tool in the diagnosis and management of diabetic ketoacidosis (DKA). However, there remains considerable disparity between diabetes guidelines regarding if, how, and when this test should be used. While recent guidelines now mainly emphasize blood measurement, several issues nonetheless remain. Many laboratories still measure blood ketones using a semiquantitative test that does not measure the predominant ketone, \u03b2-hydroxybutyrate (BOHB), which may hinder patient management. Even when BOHB is measured, the evidence for cutoffs used in DKA diagnosis or exclusion is limited, while its use in gauging severity, treatment progress, and resolution is not fully clear. Lastly, although employing point-of-care meters instead of a laboratory for BOHB measurement brings undoubted benefits, this approach has its own challenges. This article provides a perspective on these topics to complement current recommendations and to suggest how future research may improve its use in the DKA context.<\/jats:p>","DOI":"10.2337\/dc21-2279","type":"journal-article","created":{"date-parts":[[2022,1,20]],"date-time":"2022-01-20T09:55:25Z","timestamp":1642672525000},"page":"267-272","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":39,"title":["Controversies Around the Measurement of Blood Ketones to Diagnose and Manage Diabetic Ketoacidosis"],"prefix":"10.2337","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1676-0461","authenticated-orcid":false,"given":"Eric S.","family":"Kilpatrick","sequence":"first","affiliation":[{"name":"Department of Clinical Biochemistry, Manchester Royal Infirmary, Manchester, U.K."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5762-3917","authenticated-orcid":false,"given":"Alexandra E.","family":"Butler","sequence":"additional","affiliation":[{"name":"Department of Postgraduate Studies and Research, Royal College of Surgeons in Ireland, Medical University of Bahrain, Busaiteen, Bahrain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Ostlundh","sequence":"additional","affiliation":[{"name":"College of Medicine and Health Sciences, United Arab Emirates University, Al Ain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen L.","family":"Atkin","sequence":"additional","affiliation":[{"name":"Department of Postgraduate Studies and Research, Royal College of Surgeons in Ireland, Medical University of Bahrain, Busaiteen, Bahrain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David B.","family":"Sacks","sequence":"additional","affiliation":[{"name":"National Institutes of Health, Bethesda, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1167","published-online":{"date-parts":[[2022,1,17]]},"reference":[{"key":"2022031310410112000_B1","doi-asserted-by":"crossref","first-page":"818","DOI":"10.1111\/dme.12136","article-title":"Blood \u03b2-hydroxybutyrate vs. urine acetoacetate testing for the prevention and management of ketoacidosis in type 1 diabetes: a systematic review","volume":"30","author":"Klocker","year":"2013","journal-title":"Diabet Med"},{"key":"2022031310410112000_B2","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1373\/clinchem.2010.161596","article-title":"Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus","volume":"57","author":"Sacks","year":"2011","journal-title":"Clin Chem"},{"key":"2022031310410112000_B3","doi-asserted-by":"crossref","first-page":"1335","DOI":"10.2337\/dc09-9032","article-title":"Hyperglycemic crises in adult patients with diabetes","volume":"32","author":"Kitabchi","year":"2009","journal-title":"Diabetes Care"},{"key":"2022031310410112000_B4","doi-asserted-by":"crossref","first-page":"1622","DOI":"10.2337\/dc17-1624","article-title":"Standardizing clinically meaningful outcome measures beyond HbA1c for type 1 diabetes: a consensus report of the American Association of Clinical Endocrinologists, the American Association of Diabetes Educators, the American Diabetes Association, the Endocrine Society, JDRF International, The Leona M. and Harry B. 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