Durnin, SheenaSheenaDurninJones, JenniferJenniferJonesRyan, EmerEmerRyanBarrett, MichaelMichaelBarrettet al.2021-07-232021-07-232020 the A2020-11-20Archives of Disease in Childhood0003-9888http://hdl.handle.net/10197/12342Objective: 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.enThis article has been accepted for publication in Archives of Disease, 2020 following peer review, and the Version of Record can be accessed online at http://dx.doi.org/10.1136/archdischild-2019-318425. © Authors or their employees.Serum point-of-care ketonesTriageDehydrationPediatric emergency careHypoglycaemiaGorelick scalesJournal Article105121157116110.1136/archdischild-2019-3184252020-07-06https://creativecommons.org/licenses/by-nc-nd/3.0/ie/