Why the study?
How does insulin administration affect the ratio of blood 3-hydroxybutyrate to acetoacetate in ketoacidotic patients with diabetes?
How does insulin administration affect the ratio of blood 3-hydroxybutyrate to acetoacetate in ketoacidotic patients with diabetes?
During treatment of diabetic ketoacidosis, acetoacetate levels may initially increase or persist at high levels despite clinical improvement and falling 3-hydroxybutyrate and glucose levels.
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May explain acetoacetate persistence in treated DKA despite improvement; leaves open optimal ketone monitoring strategies.
The ratio of blood ketone bodies 3-hydroxybutyrate to acetoacetate, once thought to be fairly constant, has been shown to vary from 0.6:1 to 4.8:1. In untreated, ketoacidotic patients, it is directly related to the plasma free fatty acid level. Administration of insulin lowers the ratio because the fall of blood 3-hydroxybutyrate occurs earlier and more rapidly than that of acetoacetate. During the treatment of ketoacidosis there is usually an initial increase of the acetoacetate which may persist at a high levelfor several hours despite improvement of the patient and falling 3-hydroxybutyrate and glucose levels.
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Stephens et al. (1971) studied this question.
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