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Fingerprick Better than Dipstick for Identifying Diabetic Ketoacidosis

Posted: Sunday, February 27, 2011

A fingerprick test that shows ketones in capillary blood is more specific than a urine dipstick for identifying diabetic ketoacidosis.

Researchers conducted their study in an emergency department, where the point-of-care test for beta-hydroxybutyrate (OHB) in serum could cut down on unnecessary work-ups of hyperglycemic patients.

Dr. Sanjay Arora and colleagues at the University of Southern California suggest that it is far superior to the urine dip. "The urine dip is still a useful tool for many conditions, but its utility as a screening tool for DKA is a thing of the past."

He and his team compared a urine dipstick for ketones (Siemens Multistix 10SG) with a point-of-care capillary beta-OHB test (Precision Xtra meter; Medisense/Abbott Laboratories) in 516 patients with a triage capillary blood glucose level of at least 250 mg/dL.

DKA was confirmed by blood chemistries in 54 of the patients. "The sensitivity of capillary beta-OHB and the urine dipstick for DKA were identical at 98.1%," the investigators found. But beta-OHB was more than twice as specific (78.6% vs. 35.1%; p<0.01).

Consequently, while the negative predictive value of both tests was more than 99%, the positive predictive values differed substantially: 34.9% for capillary beta-OHB compared with 15.0% for the urine dipstick.

While the cost of beta-OHB testing is higher than urine dipstick testing, Dr. Arora points out, "They result in significantly less full laboratory work-ups."

Source: http://www.diabetesincontrol.com/index.php?option=com_content&view=article&id=10553&catid=53&Itemid=8, Diabetes Care, online February 9, 2011.