EBM Consult

Lab Test: Beta-Hydroxybutyrate (Blood) Level

    Lab Test
    • Beta-Hydroxybutyrate  (Blood)
    • Measurement of beta-hydroxybutyrate in whole blood, serum, or plasma to evaluate ketone-producing metabolic energy deficits that usually occur when there is insufficient carbohydrate metabolism, thereby increasing the catabolism of fatty acids.
    Reference Range
    • Whole blood, serum or plasma:  0.21 to 2.81 mg/dL (20-270 micromol/L)
    • Serum (enzymatic-kinetic technique):  <3.02 mg/dL (290 micromol/L)
    Indications & Uses
    • Suspected alcoholic ketoacidosis
    • Suspected diabetic ketoacidosis (DKA)
    Clinical Application
    • Common tests for ketone bodies, such as Acetest, Chemstrip, and Ketostix, do not detect beta-hydroxybutyrate.  A handheld meter sensor system is available to monitor beta-hydroxybutyrate and glucose levels. 
    • Elevated levels beta-hydroxybutyrate is diagnostic of ketoacidosis, whereas the absence of concomitant hyperglycemia supports the diagnosis of alcoholic ketoacidosis (AKA).
    • Levels ³ 3 mmol/L are indicative of ketoacidosis.  In very severe diabetic ketoacidosis (DKA), the beta-hydroxybutyrate serum concentration may exceed 25 mmol/L.
    • Patients presenting with isopropanol intoxication can present with high acetone levels without any acidosis, anion gap or abnormal glucoses levels.
    Related Tests
    • Urine ketones
    • Blood glucose levels
    Drug-Lab Interactions
    • None
    Test Tube Needed
    • None
    • Plasma (lithium-heparin or fluoride-oxalate), serum, or perchloric acid (PCA) extracts can be analyzed.
    • EDTA-plasma samples will produce values that are 60% lower than specimens preserved with fluoride-oxalate or PCA.
    Storage and Handling
    • Whole blood specimens are stable at room temperature up to 48 hours.
    • Plasma samples are stable at room temperature up to 7 days, 14 days at 4°C, and 6 months at -20°C.
    • PCA extracts are stable at -20°C up to 1 year.
    • Repeated freeze-thaw cycling has no detrimental effect.
    What To Tell Patient Before & After
    • None
    • Foreback CC.  Beta-hydroxybutyrate and acetoacetate levels.  Am J Clin Pathol 1997;108(5):602-4.
    • Porter WH et al. Laboratory and clinical evaluation of assays for beta-hydroxybutyrate. Am J Clin Pathol 1997;107(3):353-8.
    • LaGow B et al., eds. PDR Lab Advisor. A Comprehensive Point-of-Care Guide for Over 600 Lab Tests.  First ed. Montvale, NJ: Thomson PDR; 2007.

MESH Terms & Keywords

  • Beta Hydroxybutyrate, Ketones, Diabetic Ketoacidosis Labs