The utility of ketones at triage: a prospective cohort study

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Title: The utility of ketones at triage: a prospective cohort study
Other Titles: Ketones in non-diabetic children with vomiting, diarrhoea or reduced intake: a prospective cohort study
Authors: Durnin, SheenaJones, JenniferRyan, EmerBarrett, Michaelet al.
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Date: 20-Nov-2020
Online since: 2021-07-23T15:21:41Z
Abstract: Objective: To establish the relationship between serum point-of-care (POC) ketones at triage with clinical dehydration based on the validated Gorelick scales. Design, setting and patients: Prospective unblinded exploratory study fromApril 2016 to February 2017in a tertiary paediatric Emergency Department. Patients aged 1 month to 5 years, with vomiting and/or diarrhoea and/or decreased intake with signs of dehydration or clinical concern for hypoglycaemia were eligible. Main outcome measures: POC ketones were analysed at triage and 4-hours later or upon discharge if earlier.Secondary outcomes were to examine the response of ketone levels to fluid/glucose administration and patient disposition. Results:Two-hundred and one attendances were included(198 patients); median age 1.8years. The median triage ketones were 4.4 (interquartile range (IQR) 2.8–5.6) mmol/L. Aweak correlation was identified between triage ketones and 10-point Gorelick scale (Pearson r=0.215), however the 4-point Gorelick scale was non-significant. Those admitted to hospital had median triage ketones of 5.2 (IQR 5-6) mmol/L and repeat ketones of 4.6 (IQR 3.3-5.7) mmol/L compared to 4.2 (IQR 2.4–5.2) mmol/Land 2.9 (IQR 1.6–4.2) mmol/L in those discharged home. Conclusion: Elevated POC ketones were demonstrated in non-diabetic childrenwith acute illness. A weak correlation was demonstrated between triage POC ketones and the 10-point Gorelick scale, however,this was not demonstrated with the 4-point Gorelick scale. The use of POC ketones, at triage and at 4-hours,to predict the patient’s disposition had poor and fair accuracy respectively. Ketosis and the potential impact of tailored treatments in paediatric acute illness warrants further research.
Type of material: Journal Article
Publisher: BMJ
Journal: Archives of Disease in Childhood
Volume: 105
Issue: 12
Start page: 1157
End page: 1161
Copyright (published version): 2020 the Authors
Keywords: Serum point-of-care ketonesTriageDehydrationPediatric emergency careHypoglycaemiaGorelick scales
DOI: 10.1136/archdischild-2019-318425
Language: en
Status of Item: Peer reviewed
ISSN: 0003-9888
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