What is the role of a serum ketone test in the workup of alcoholic ketoacidosis (AKA)?

Updated: Aug 27, 2020
  • Author: George Ansstas, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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All patients with AKA have ketonuria and most have ketonemia. In AKA, the average ratio of hydroxybutyric acid (β-OH) to acetoacetic acid (5:1) tends to be higher than that which occurs in diabetic ketoacidosis (3:1). [5, 12, 11] The nitroprusside reaction (Acetest) may be negative or only weakly positive for serum ketones in AKA because nitroprusside reacts with acetone and acetoacetic acid, but not with β-OH. [5, 24] Direct serum measurements of β-OH should be used when available.

With initial therapy, ketone formation shifts toward the production of acetoacetic acid. Measured ketone levels rise, although β-OH levels decrease.

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