Useful For

The measurement of Beta-hydroxybutyrate (BHB) is the preferred method for diagnosing and monitoring diabetic ketoacidosis.  Serum ketone determination using nitroprusside reagent is often used to estimate ketone body status, but that method has inherent problems. The nitroprusside reagent only reacts with acetoacetate and acetone and does not measure BHB, the most abundant of the physiological ketone bodies. 

BHB measurement is also useful for investigating the diagnosis of patients presenting to the emergency room with hypoglycemia, acidosis, suspected alcohol ingestion, or an unexplained increase in the anion gap. 

In pediatric patients, the presence or absence of ketonemia/uria is an essential component in the differential diagnosis of inborn errors of metabolism.

Serum beta-hydroxybutyrate is a key parameter monitored during controlled 24-hour fasts.  Serum BHB increases in response to fasting, but should not exceed 0.4 mmol/L following an overnight fast up to 12 hours.