Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA.
Acad Emerg Med. 2013 Nov;20(11):1146-50. doi: 10.1111/acem.12256.
Children with gastroenteritis often develop dehydration with metabolic acidosis. Serum ketones are frequently elevated in this population. The goal was to determine the relationship between initial serum ketone concentration and both the degree of dehydration and the magnitude of acidosis.
This was a secondary analysis of a prospective trial of crystalloid administration for rapid rehydration. Children 6 months to 6 years of age with gastroenteritis and dehydration were enrolled. A point-of-care serum ketone (beta-hydroxybutyrate) concentration was obtained at the time of study enrollment. The relationship between initial serum ketone concentration and a prospectively assigned and previously validated clinical dehydration score, and serum bicarbonate concentration, was analyzed.
A total of 188 patients were enrolled. The median serum ketone concentration was elevated at 3.1 mmol/L (interquartile range [IQR] = 1.2 to 4.6 mmol/L), and the median dehydration score was consistent with moderate dehydration. A significant positive relationship was found between serum ketone concentration and the clinical dehydration score (Spearman's rho = 0.22, p = 0.003). Patients with moderate dehydration had a higher median serum ketone concentration than those with mild dehydration (3.6 mmol/L vs. 1.4 mmol/L, p = 0.007). Additionally, the serum ketone concentration was inversely correlated with serum bicarbonate concentration (ρ = -0.26, p < 0.001).
Children with gastroenteritis and dehydration have elevated serum ketone concentrations that correlate with both degree of dehydration and magnitude of metabolic acidosis. Point-of-care serum ketone measurement may be a useful tool to inform management decisions at the point of triage or in the initial evaluation of children with gastroenteritis and dehydration.
患有肠胃炎的儿童常伴有脱水和代谢性酸中毒。该人群的血清酮体通常升高。本研究旨在确定初始血清酮浓度与脱水程度和酸中毒程度之间的关系。
这是一项关于晶体制剂快速补液的前瞻性试验的二次分析。纳入患有肠胃炎和脱水的 6 个月至 6 岁儿童。在研究入组时，获得即时检测的血清酮（β-羟丁酸）浓度。分析初始血清酮浓度与前瞻性分配的、先前验证的临床脱水评分和血清碳酸氢盐浓度之间的关系。
共纳入 188 例患者。中位血清酮浓度升高至 3.1mmol/L（四分位距 [IQR] = 1.2 至 4.6mmol/L），中位脱水评分为中度脱水。血清酮浓度与临床脱水评分呈显著正相关（Spearman's rho = 0.22，p = 0.003）。中度脱水患者的血清酮浓度中位数高于轻度脱水患者（3.6mmol/L 比 1.4mmol/L，p = 0.007）。此外，血清酮浓度与血清碳酸氢盐浓度呈负相关（ρ = -0.26，p < 0.001）。
患有肠胃炎和脱水的儿童血清酮浓度升高，与脱水程度和代谢性酸中毒程度相关。即时检测血清酮浓度可能是分诊或评估肠胃炎和脱水儿童时，辅助管理决策的有用工具。
