Breath ketone testing: a new biomarker for diagnosis and therapeutic monitoring of diabetic ketosis
Yue Qiao, Zhaohua Gao, Yong Liu, Yan Cheng, Mengxiao Yu, Lingling Zhao, Yixiang Duan, Yu Liu, Yue Qiao, Zhaohua Gao, Yong Liu, Yan Cheng, Mengxiao Yu, Lingling Zhao, Yixiang Duan, Yu Liu
Abstract
Background: Acetone, β -hydroxybutyric acid, and acetoacetic acid are three types of ketone body that may be found in the breath, blood, and urine. Detecting altered concentrations of ketones in the breath, blood, and urine is crucial for the diagnosis and treatment of diabetic ketosis. The aim of this study was to evaluate the advantages of different detection methods for ketones, and to establish whether detection of the concentration of ketones in the breath is an effective and practical technique.
Methods: We measured the concentrations of acetone in the breath using gas chromatography-mass spectrometry and β -hydroxybutyrate in fingertip blood collected from 99 patients with diabetes assigned to groups 1 (-), 2 (±), 3 (+), 4 (++), or 5 (+++) according to urinary ketone concentrations.
Results: There were strong relationships between fasting blood glucose, age, and diabetic ketosis. Exhaled acetone concentration significantly correlated with concentrations of fasting blood glucose, ketones in the blood and urine, LDL-C, creatinine, and blood urea nitrogen.
Conclusions: Breath testing for ketones has a high sensitivity and specificity and appears to be a noninvasive, convenient, and repeatable method for the diagnosis and therapeutic monitoring of diabetic ketosis.
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References
- Bonadio W. Pediatric diabetic ketoacidosis: an outpatient perspective on evaluation and management. Pediatric Emergency Medicine Practice. 2013;10:1–14.
- Drouin P, Blickle JF, Charbonnel B, et al. Diagnosis and classification of diabetes mellitus: the new criteria. Diabetes and Metabolism. 1999;25(1):72–83.
- Zhou MG, Liu Y, Li WW, et al. Investigation and identification of breath acetone as a potential biomarker for type 2 diabetes diagnosis. Chinese Science Bulletin. 2014
- Westerberg DP. Diabetic ketoacidosis: evaluation and treatment. American Family Physician. 2013;87:337–346.
- Fritsch M, Schober E, Rami-Merhar B, Hofer S, Frohlich-Reiterer E, Waldhoer T. Diabetic ketoacidosis at diagnosis in Austrian children: a population-based analysis, 1989–2011. The Journal of Pediatrics. 2013;163(5):1484–1488.
- Klingensmith GJ, Tamborlane WV, Wood J, et al. Diabetic ketoacidosis at diabetes onset: still an all too common threat in youth. The Journal of Pediatrics. 2013;162(2):330.e1–334.e1.
- Miekisch W, Schubert JK, Noeldge-Schomburg GFE. Diagnostic potential of breath analysis—focus on volatile organic compounds. Clinica Chimica Acta. 2004;347(1-2):25–39.
- Turner C, Spanel P, Smith D. A longitudinal study of ammonia, acetone and propanol in the exhaled breath of 30 subjects using selected ion flow tube mass spectrometry, SIFT-MS. Physiological Measurement. 2006;27(4):321–337.
- Yamane N, Tsuda T, Nose K, Yamamoto A, Ishiguro H, Kondo T. Relationship between skin acetone and blood β-hydroxybutyrate concentrations in diabetes. Clinica Chimica Acta. 2006;365(1-2):325–329.
- Deng C, Zhang J, Yu X, Zhang W, Zhang X. Determination of acetone in human breath by gas chromatography-mass spectrometry and solid-phase microextraction with on-fiber derivatization. Journal of Chromatography B: Analytical Technologies in the Biomedical and Life Sciences. 2004;810(2):269–275.
- Zeugswetter F, Pagitz M. Ketone measurements using dipstick methodology in cats with diabetes mellitus. Journal of Small Animal Practice. 2009;50(1):4–8.
Source: PubMed