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The clinical utility of beta hydroxybutyrate is an analyte in the laboratory so the first case i want to cover is actually a pediatric 13 year old Caucasian female. She’s overweight has no past medical history family history of type 1 diabetes and she’s going to her primary care practitioner with the two-week history of polydipsia polyuria a 20-pound weight loss. She seems not too big to complain to the primary care practitioner was she can get enough to drink she was waking up several times at night to urinate and at the physician’s office she had a capillary glucose of about 440 4 milligrams per deciliter and your analysis done at the physician’s office was a 4 plus ketones, so she was transferred to our emergency department and her ph was low she was acid addict had a high serum glucose.
Her bicarb was very low so sure anion gap was up she had a high beta hydroxybutyrate it was 8.46 and the normal range for those of you who aren’t familiar with it is 0-2 0.27 millimoles per liter. So this was orders of magnitude above the normal range and her sodium was 137 141. When you correct it for hyperglycemia now the second case we want to talk about is an african-american female 58 year-old. No previous history of diabetes she shows up in the emergency room with one week history of fatigue polyuria polydipsia. Blurry vision again her capillary glucose glucose meter was 380 mclogan a1c with 16.1 percent and again this was a little bit of a higher ni gap not as high as the last one was 33 better ketones on glucose 4+4 by dipstick and the beta hydroxy butyrate was in the 6.86 range, again very elevated.
Then we have case 3 here is a 57-year old caucasian male is poorly controlled type 2 diabetes he’s been diagnosed with his past history of reflux esophagitis alcohol abuse cirrhosis. He comes to the emergency room with vomiting blood abdominal pain is a recent history of increased alcohol consumption has not been eating or taking his insulin and i Just forgot is he was drinking so its pH was borderline at the low again in the idiotic range reporter line in the norm low. Normal glucose was elevated but not as elevated as the previous ones by carp was very low and I gap super-high lactate was up beta hydroxybutyrate. You can see was elevated about 10 times the normal limit blood-alcohol of 209 which is quite impressive and ketones was 2 plus so it just kind of brings home as you look at these pictures and the similarities between three different cases three different people showing up in the emergency room with similar and dissimilar analysis.
They all kind of surround the ketone bodies and in all of these cases these patients had elevated ketone bodies. So what is a ketone bodies well it’s actually a wood there are three of them they are water soluble compounds produced by products when fatty acids are actually metabolizer broken down by the liver beta hydroxybutyrate acetoacetate and acetone. Acetone is volatile beta hydroxybutyrate and acetoacetate are not so there are stable in serum after process.
You don’t have to really remember to keep the cap on there. In other words, normally when the body breaks down ketones they break them down into co2 and h2o. Well, but the build-up of ketones causes an acid in balance and that’s where you get the ketone bodies. Both bodies actually if you look at this absolutely go back here so don’t have a pointer if you look at the beta hydroxybutyrate it’s butyric acid. So that gives you that the acid that is the unbound or unrecognized and the anion gap so it is one of the elements that’s causing the increase tell any gaps along with the keto acetic acid if it’s not diagnosed and treated ketoacidosis can be fatal. I do want to point out that in normal patients acetoacetate to beta hydroxybutyrate ratio is normally about 121 but when you go into ketoacidosis acetoacetate to beta-hydroxybutyrate is about a 126 ratio meaning beta-hydroxybutyrate outnumbers acetoacetate an acetone by about a 6 to 1 ratio beta-hydroxybutyrate. In other words, is favored in the ketosis states, so I want to point out here, that actually these are byproducts of metabolism and whether you are actually in the absence or presence of insulin.
BHB is a Molecule: 0:50
Beta Hydroxybutyrate 4:00
Ketone Supplement 5:00
Wrap Up 5:45
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