Dear David and Janice
The Optium ketone meter is supposed to read 'HI' if the betahydroxybutyrate
exceeds 6 mmol/L. If your meter doesn't you should speak to MediSense.
Guidance on clinical management of DKA incorporating ketones was published
in Diabetic Medicine 2001; 18: 640-5. Wallace TM, Meston NM, Gardner SG,
Matthews DR, The hospital and home use of a 30-second hand-held blood ketone
meter: guidelines for clinical practice.
According to this work the upper threshold for management is at 3mmol/L.
Betahydroxybutyrate can of course be higher than 6 on admission, but a meter
result of >6 rather than a specific value shouldn't detract too much from
its clinical usefulness; bicarbonate or blood gases will complement the
ketones. If patients have their glucose and ketones monitored at hourly
intervals it should be clear if initial treatment is adequate using the
glucose as the key indicator even if the ketones remain above 6. The
insulin dose should be guided primarily by the rate of fall of glucose. As
the glucose falls the ketones should too, and when betahydroxybutyrate
reaches 1 mmol/L, a switch from IV to subcutaneous insulin can be
considered, if other factors permit.
Best regards
Dr Richard Taylor
Consultant Clinical Scientist
Dept of Clinical Biochemistry
John Radcliffe Hospital
Oxford OX3 9DU
tel 01865 220477
> ----------
> From: Dave Hullin
> Reply To: ACB Point of Care Testing List
> Sent: Thursday, August 28, 2003 10:32 am
> To: [log in to unmask]
> Subject: Re: Optium ketone strips
>
> Dear Janice
>
> We did a brief evaluation of these and showed acceptable correlation with
> laboratory-measured hydroxybutyrate up to a level of about 6 mmol/L.
> Above
> that, at least in our hands, the Optium continued to give a level of
> 6mmol/L even if the measured plasma hydroxybutyrate was as high as 12
> mmol/L. I would be interested to know if anyone else has noted this
> phenomenon.
>
> I'm not sure how important it is clinically to distinguish high from very
> high levels but I would have been more reassured if such samples had at
> least been flagged as greater than the measurable range rather than giving
> an apparent value.
>
> Regards
>
> Dave Hullin
>
> Dr D A Hullin
> Department of Clinical Biochemistry
> Royal Glamorgan Hospital
> Ynysmaerdy
> Llantrisant
> CF72 8XR
> Tel: 01443 443358
>
> > -----Original Message-----
> > From: Janice Still [SMTP:[log in to unmask]]
> > Sent: 27 August 2003 16:54
> > To: [log in to unmask]
> > Subject: Optium ketone strips
> >
> > Has anyone experience of using ketone strips with the
> > Medisense Optium blood glucose meter? I have
> > reservations about the use of these, apart from the
> > cost, and would be interested in whether these are
> > seen as clinically useful and what criteria are
> > applied to their use.
> > Thanks.
> > Jan
> >
> > =====
> > Mrs. J. Still,
> > POCT Manager,
> > Biochemistry Dept,
> > Watford General Hospital. 01923-217998.
> > The views expressed in this message are personal and do not reflect West
> > Herts NHS Hospitals Trust policy.
> >
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