Ketone bodies are an important alternate fuel source with fasting. Our aim was to describe point of care blood beta hydroxybutyrate (BHB) in patients presenting to emergency (ED). We performed a retrospective study. The population consisted of adult patients attending emergency department of a tertiary referral hospital who had a BHB measurement and venous blood gas measurement (VBG) performed at presentation to ED. Between March-September 2018 inclusive, 4356 patients had at least one VBG performed, and of these 842 patients had at least one BHB level performed whilst in ED. Of the whole cohort, 604 patients were admitted and 238 discharged from ED or short stay ward. Results are shown as mean±SD (range). Age was 62.5±21.6 years (16.1-102.5). 55% of cohort were male. Length of stay was 6.23±9.99 days (0.35-77.77), and Charlson score 1.91±2.03 (0-15). Blood glucose (BG) was 10.5 ±7.3mmol/L (2-54mmol/L), lactate 2.2±1.7mmol/L (0.3-21), and BHB 0.6±1.2mmol/L (0-8.4). Of the whole cohort, 404 patients had diabetes. Excluded from subsequent analysis were 18 cases of diabetic ketoacidosis and 6 cases of hyperosmotic hyperglycaemic syndrome. Of this cohort, BHB level did not differ according to diabetes status (0.52±0.9mmol/L those with diabetes versus 0.41±0.75mmol/L in those without) yet BG (13.7±7.4mmol/L versus 6.8±2.8mmol/L, p<0.01) was higher as was lactate (2.3±1.6mmol/L versus 2.1±1.8mmol/L, p<0.05). Where acute vomiting was documented to be present versus not recorded, BHB was higher (0.64±1.0 mmol/L versus 0.43±0.81mmol/L). Where acute ethanol intake was documented, BHB was not significantly higher (0.66±1.34mmol/L versus 0.44±0.79mmol/L). BHB ≥3mmol/L was seen in 2.9% of those with diabetes and 2.1% of those without diabetes. Although serum albumin was no different, BMI was lower in those with BHB ≥ 3mmol/L (23.5±7.7kg/m2 versus 27.6±6.9kg/m2). Ketosis is commonly seen in ED, is associated with reduced oral intake and is not confined to those with diabetes.
B. Depczynski: None. A.T. Lee: None. W.F. Varndell: None. A.L. Chiew: None.