Accuracy of blood beta-hydroxybutyrate and plasma acetoacetate for diagnosis of canine diabetic ketoacidosis

Diabetic ketoacidosis (DKA) is a life-threatening complication in diabetic dogs. It is caused by an increase in production and accumulation of ketone bodies in the blood, which results in metabolic acidosis. The objective of this study was to compare the diagnostic accuracy between the measurement of blood beta-hydroxybutyrate (β-OHB) concentration using a point-of-care sensor and plasma acetoacetate (AcAc) level using a urine strip test for the diagnosis of canine DKA. A total of 60 dogs were enrolled into each group: DKA (n=16), diabetic ketosis (DK) (n=5), and control (n=39). The following parameters including blood β-OHB, plasma AcAc, blood glucose, urinary AcAc, urinary glucose, and blood gas analysis were evaluated and compared among the groups. Both DKA and DK groups had higher concentrations of blood β-OHB and blood glucose than the control group (P<0.001), but no statistical difference was found between the DKA and DK groups. Likewise, plasma and urinary AcAc were detected only in the DKA and DK dogs, but there were no significant differences between the groups. The sensitivity and specificity of the β-OHB POC sensor had a wide variation at various cut-off values. However, the cut-off value of blood β-OHB concentration at 2.1 mmol/L revealed 100% sensitivity. The sensitivity and specificity of plasma AcAc varied extensively at cut-off values ranging from 0 to 3+. Therefore, the presence or absence of plasma AcAc could not be used to diagnose dogs with DKA. Instead, blood β-OHB at the concentration of >2.1 mmol/L should be used for the screening of DKA.