Background: Diabetic ketoacidosis (DKA) is an acute metabolic complication of diabetes resulting from absolute or relative insulin deficiency associated with elevated counter-regulatory hormones, leading to excessive ketone body production and metabolic acidosis. Early diagnosis relies on the detection of ketone bodies using either urinary ketone testing or blood ketone measurement.
Objective: To compare the diagnostic performance of semi-quantitative urinary acetoacetate measurement using conventional urine dipsticks with quantitative capillary blood 3-beta-hydroxybutyrate (3-HB) measurement in the diagnosis of diabetic ketoacidosis.
Methods: This prospective, observational, comparative, and analytical study was conducted between March 1 and June 1, 2025, at Medical Clinic II of Abass Ndao Hospital. A total of 54 patients admitted with capillary blood glucose levels ≥ 2.5 g/L were included and equally divided into two groups: patients with DKA and patients with isolated hyperglycemia (IHG).
Results: The mean age was 46.28 ± 16.12 years, with a male predominance (sex ratio: 1.4). Type 2 diabetes mellitus predominated in both groups. Patients with DKA more frequently presented with altered consciousness, Kussmaul respiration, and anorexia. At admission, mean blood glucose levels were higher in the DKA group (4.54 g/L vs. 3.50 g/L). Mean blood ketone levels were significantly higher in the DKA group (5.13 mmol/L vs. 0.38 mmol/L). Urinary ketone levels exceeded two crosses in all patients with DKA. During treatment, blood glucose, blood ketone levels, and urinary ketones decreased significantly and in parallel, with earlier normalization of blood ketones observed within the first eight hours. Urinary ketone testing demonstrated higher sensitivity (100%) than blood ketone measurement (96.4%), whereas blood ketone measurement showed perfect specificity (100%), thereby reducing false-positive diagnoses of DKA.
Conclusion: Although widely available, urinary ketone testing is less accurate and slower than capillary blood ketone measurement and may inadequately reflect DKA severity. Blood ketone measurement enables earlier and more accurate diagnosis and monitoring of DKA and may help reduce intensive care unit length of stay.