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22242 Beta-Hydroxybutyrate

Beta-Hydroxybutyrate
Test Code: BOH
Synonyms/Keywords
Hydroxybutyrate, Ketones, 3-hydroxybutyrate
Useful For

Monitoring diabetic ketoacidosis.

To investigate the differential diagnosis of any patient presenting to the emergency room with hypoglycemia, acidosis, suspected alcohol ingestion, or an unexplained increase in the anion gap.  In pediatric patients, useful as a differential diagnosis for an in-born error and monitoring ketogeic diet patients.

Specimen Requirements
Fasting Required Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
No​ Plasma, Serum
Lithium-heparin Plasma Separator Tube (PST)
Lithium or Sodium heparin Green Top Tube (GTT), Serum Separator Tube (SST), Red Top Tube (RT)
 0.5 mL​ ​0.3 mL 0.1 mL​
Collection Processing Instructions
​Separate plasma or serum from the blood within 60 minutes of venipuncture. 
For referred samples and split samples, aliquot into secondary container and cap immediately.
Specimen must be free of particulate matter including fibrin. 
The frozen specimens should be completely thawed thoroughly, mixed and centrifuged before analysis.  
Specimen Stability Information
Specimen Type Temperature Time
Plasma ​ ​Ambient ​2 hours
​Refrigerate ​7 days
​Frozen at -20 deg Celsius ​30 days
Rejection Criteria
Plasma samples in wrong anticoagulant.
Marshfield: Gross Hemolysis​
Flambeau, Lakeview, DTC: Moderate or Gross Hemolysis
Specimens not separated from cells within 60 minutes.
​Specimens stored or transported at room temperature for more than 2 hours.
Interference
Marshfield: Gross hemolysis.
Flambeau, Lakeview, DTC: Moderate hemolysis, gross icterus or lipemia. 
Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
Diagnostic and Treatment Center​ ​Monday through Sunday ​Less than 2 hours ​Reflectance photometry/Coupled enzyme reactions/Stanbio STAT-Site M B-Hydroxybutyrate Photometer
​Eau Claire ​Monday through Sunday ​Less than 2 hours ​Reflectance photometry/Coupled enzyme reactions/Stanbio STAT-Site
M B-Hydroxybutyrate Photometer
Flambeau Hospital​ ​Monday through Sunday ​Less than 2 hours ​Reflectance photometry/Coupled enzyme reactions/Stanbio STAT-Site
M B-Hydroxybutyrate Photometer
​Ladysmith Medical Center ​Monday through Sunday ​Less than 2 hours ​Reflectance photometry/Coupled enzyme reactions/Stanbio STAT-Site
M B-Hydroxybutyrate Photometer
​Lakeview Medical Center ​Monday through Sunday ​Less than 2 hours ​Reflectance photometry/Coupled enzyme reactions/Stanbio STAT-Site
M B-Hydroxybutyrate Photometer
Marshfield​ Monday through Sunday​ Less than 2 hours​ BHB LiquiColor Enzymatic Endpoint Assay/Beckman AU
​Minocqua​Monday through Sunday​Less than 2 hours​Reflectance photometry/Coupled enzyme reactions/Stanbio STAT-Site
M B-Hydroxybutyrate Photometer
​Neillsville​Monday through Sunday​Less than 2 hours​Reflectance photometry/Coupled enzyme reactions/Stanbio STAT-Site
M B-Hydroxybutyrate Photometer

 

Test Information

Beta-Hydroxybutyrate (BOH) is the predominant ketone body in the blood.  It is the most sensitive marker for detecting ketosis.  The American Diabetes Association has recommended BOH as the preferred method for diagnosing and monitoring treatment of diabetic ketoacidosis. 

Ketone bodies are catabolic products of free fatty acids.  Beta-hydroxybutyrate accounts for 78% of ketone bodies in the blood; the other two are acetoacetate (20%) and acetone (2%).  Although ketone bodies are acidic, normal renal and respiratory functions compensate for ketogenesis and maintain acid-base homeostasis.  In ketoacidosis, these physiological mechanisms are unable to compensate for the ketone bodies produced.  The excess accumulates and the blood pH is lowered to acidic levels.

BOH is increased in alcoholic ketoacidosis, lactic acidosis (shock, renal failure), liver disease, infections, and salicylate poisoning.

BOH has been shown to allow a better management of patients with seizure reduction than urinary ketones in patients on ketogenic diet with refractory epilepsy.  Ketosis in urine only indicates compliance but not of value in terms of efficacy.

Dipstick serum ketone determination using nitroprusside reagent is often used to estimate ketone body status, but that method has inherent problems.  The dipstick does not measure beta-hydroxybutyrate, the most abundant if the physiological ketone bodies; the nitroprusside reagent only reacts with acetoacetate and acetone.

Although BOH performed on Stanbio meter method correlates well to the Stanbio liquid method, results are not directly comparable.  Individual results show significant biases acrosss methodologies.  Results should not be intermixed when serially tracking a patient. 

Reference Range Information
Performing Location Reference Range
All Performing Sites < 0.40 mmol/L​
Interpretation

The beta-hydroxybutyrate (BOH)/acetoacetate ratio is normally 3:1.  This ratio increases to 6:1 or 12:1 during severe ketotic states.

Beta-hydroxybutyrate increases in response to fasting, but should not exceeed 0.4 mmol/L following an overnight fast (up to 12 hours).

In pediatric patients, a hypo- or hyper-ketotic state (with or without hypoglycemia) may suggest specific groups of metabolic disorders.

Outreach CPTs
CPT Modifier
(if needed)		 Quantity Description Comments
82010 ​ ​ ​ ​ ​
Synonyms/Keywords
Hydroxybutyrate, Ketones, 3-hydroxybutyrate
Ordering Applications
Ordering Application Description
​Cerner ​Beta Hydroxybutyrate (BOH)
If the ordering application you are looking for is not listed, contact your local laboratory for assistance.
Specimen Requirements
Fasting Required Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
No​ Plasma, Serum
Lithium-heparin Plasma Separator Tube (PST)
Lithium or Sodium heparin Green Top Tube (GTT), Serum Separator Tube (SST), Red Top Tube (RT)
 0.5 mL​ ​0.3 mL 0.1 mL​
Collection Processing
​Separate plasma or serum from the blood within 60 minutes of venipuncture. 
For referred samples and split samples, aliquot into secondary container and cap immediately.
Specimen must be free of particulate matter including fibrin. 
The frozen specimens should be completely thawed thoroughly, mixed and centrifuged before analysis.  
Specimen Stability Information
Specimen Type Temperature Time
Plasma ​ ​Ambient ​2 hours
​Refrigerate ​7 days
​Frozen at -20 deg Celsius ​30 days
Rejection Criteria
Plasma samples in wrong anticoagulant.
Marshfield: Gross Hemolysis​
Flambeau, Lakeview, DTC: Moderate or Gross Hemolysis
Specimens not separated from cells within 60 minutes.
​Specimens stored or transported at room temperature for more than 2 hours.
Interference
Marshfield: Gross hemolysis.
Flambeau, Lakeview, DTC: Moderate hemolysis, gross icterus or lipemia. 
Useful For

Monitoring diabetic ketoacidosis.

To investigate the differential diagnosis of any patient presenting to the emergency room with hypoglycemia, acidosis, suspected alcohol ingestion, or an unexplained increase in the anion gap.  In pediatric patients, useful as a differential diagnosis for an in-born error and monitoring ketogeic diet patients.

Reference Range Information
Performing Location Reference Range
All Performing Sites < 0.40 mmol/L​
Interpretation

The beta-hydroxybutyrate (BOH)/acetoacetate ratio is normally 3:1.  This ratio increases to 6:1 or 12:1 during severe ketotic states.

Beta-hydroxybutyrate increases in response to fasting, but should not exceeed 0.4 mmol/L following an overnight fast (up to 12 hours).

In pediatric patients, a hypo- or hyper-ketotic state (with or without hypoglycemia) may suggest specific groups of metabolic disorders.

For more information visit:
Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
Diagnostic and Treatment Center​ ​Monday through Sunday ​Less than 2 hours ​Reflectance photometry/Coupled enzyme reactions/Stanbio STAT-Site M B-Hydroxybutyrate Photometer
​Eau Claire ​Monday through Sunday ​Less than 2 hours ​Reflectance photometry/Coupled enzyme reactions/Stanbio STAT-Site
M B-Hydroxybutyrate Photometer
Flambeau Hospital​ ​Monday through Sunday ​Less than 2 hours ​Reflectance photometry/Coupled enzyme reactions/Stanbio STAT-Site
M B-Hydroxybutyrate Photometer
​Ladysmith Medical Center ​Monday through Sunday ​Less than 2 hours ​Reflectance photometry/Coupled enzyme reactions/Stanbio STAT-Site
M B-Hydroxybutyrate Photometer
​Lakeview Medical Center ​Monday through Sunday ​Less than 2 hours ​Reflectance photometry/Coupled enzyme reactions/Stanbio STAT-Site
M B-Hydroxybutyrate Photometer
Marshfield​ Monday through Sunday​ Less than 2 hours​ BHB LiquiColor Enzymatic Endpoint Assay/Beckman AU
​Minocqua​Monday through Sunday​Less than 2 hours​Reflectance photometry/Coupled enzyme reactions/Stanbio STAT-Site
M B-Hydroxybutyrate Photometer
​Neillsville​Monday through Sunday​Less than 2 hours​Reflectance photometry/Coupled enzyme reactions/Stanbio STAT-Site
M B-Hydroxybutyrate Photometer

 

For billing questions, see Contacts
Outreach CPTs
CPT Modifier
(if needed)		 Quantity Description Comments
82010 ​ ​ ​ ​ ​
For most current information refer to the Marshfield Laboratory online reference manual.