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, β-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.

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关于通过测量血酮来诊断和治疗糖尿病酮症酸中毒的争议

相对于尿酮，血酮的测量已成为诊断和治疗糖尿病酮症酸中毒 (DKA) 的成熟工具。然而，关于是否、如何以及何时应使用该测试的糖尿病指南之间仍然存在相当大的差异。虽然最近的指南主要强调血液测量，但仍然存在一些问题。许多实验室仍然使用半定量测试来测量血酮，该测试不测量主要的酮，β-羟基丁酸（BOHB），这可能会妨碍患者管理。即使测量了 BOHB，用于 DKA 诊断或排除的临界值的证据也是有限的，而其在衡量严重程度、治疗进展和解决情况方面的用途尚不完全清楚。最后，尽管使用现场护理仪表而不是实验室进行 BOHB 测量带来了毫无疑问的好处，但这种方法也有其自身的挑战。本文提供了关于这些主题的观点，以补充当前的建议，并建议未来的研究如何改进其在 DKA 背景下的使用。