Beta Hydroxy (BHB) Lab Values

While it’s not a “true” ketoacid in chemical terms, it is recognized as the most highly sensitive substance to test for in ketoacidosis, when measured via the blood.

BHB:

Synthesized in the liver
Produced when glucose is low
- Prolonged exercise
- Starvation
- Absence of dietary carbohydrates

Indications:

Etiology of acidotic state
- DKA
- Alcoholic ketoacidosis
- Unexplained increase in the anion gap
- Hyperinsulinemic hypoglycemic state
Controlled 24-hour fasts

Normal Therapeutic Values:

Normal –

<0.4 mmol/L

Collection:

Plasma separator preferred

What would cause increased levels?

DKA
- Any premeditating triggers
Elevated anion gap metabolic acidosis
Keto diet
Insulin omission- hyperosmolar hyperglycemic state
Carbohydrate deprivation
- Starvation
- Excessive vomiting
- Digestive disturbances
Prolonged fasting
Excessive alcohol consumption

What would cause decreased levels?

Correction of ketoacidosis

Insulin
Fluids
Carbohydrate metabolism

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Transcript

Hi, my name’s Abby. I’m here with nursing.com and in this lesson, we’ll discover the reason for drawing a beta hydroxy lab. We’ll talk about normal values and cases and conditions when we might see it increased or decreased, let’s get started!

Beta hydroxybutyrate or abbreviated as BHB measures and evaluates for ketoacidosis. BHBs are produced as a product of fatty acid metabolism and 75% of all acids produced in ketosis are BHB. Now, it’s synthesized in the liver and produced when glucose is low. This can happen in the times of prolonged exercise, starvation, and in the absence of D dietary carbohydrates. Because, when all of these meat products are consumed, it’s mostly a lot of fat, right? Tons of protein too, but that fatty acid metabolism is what puts us in ketosis.

Some clinical indications for drawing this lab are to find out why a patient isn’t in an acidotic state. S,o someone may show up with diabetic ketoacidosis, or alcoholic ketoacidosis. It can also be drawn in the case of an increase in the anion gap, or with hyperinsulinemic hypoglycemic state, HHS. We’ll also see it drawn in controlled 24 hour fasts. Now, I included this insulin syringe because if there is insulin, what does it do? Insulin allows the glucose to go through the cell receptor on the cell wall, right? And so if there’s insulin, then we shouldn’t have ketosis, but if there’s not insulin, like in the case of DKA, or when we have ketoacidosis, we know that it’s fatty acids that are being produced, or ketones are actually being metabolized.

Normal therapeutic values are below 0.4 millimoles per liter. Ketones, there’s not a large abundance unless you’re trying. Collection happens via a plasma separator tube like this green top. Lab values will be increased with diabetic ketoacidosis, and it can be a result of any of those pre-meditating triggers, so this could be just, you know, low intake of food, it could be with diabetes. If there’s no insulin right, that sugar isn’t able to get into the cell, so therefore the body goes into ketoacidosis. It could be elevated during a time of the elevation and the anion gap, which means we have metabolic acidosis, or if someone’s on the keto diet. HHS is in a time of insulin omission, so if the cells are so resistant to insulin, even in a non type one diabetic state, we can see ketones being produced. Now, it’s largely going to be evident when there’s carbohydrate deprivation, or deprivation of the sugars being able to get into the cell, like in the case of diabetes. It could be starvation, excessive vomiting, and digestive disturbances. We might also see ketosis with prolonged fasting, or excessive alcohol consumption like we talked about with alcoholic ketoacidosis. This value will be decreased in the correction of ketoacidosis, and these are the three really important pieces of correcting ketoacidosis. Of course, they’re gonna need insulin so that that glucose can be driven into the cells. Fluids are super, super duper, super important in the treatment, right? Because, that’s going to help make the blood far less viscous and move things along, and then also when carbohydrates are introduced and metabolized, we’re going to have a lack of keto production.

Now, our linchpins are that BHB or beta hydroxybutyrate is produced in the absence of carbohydrate metabolism, and it’s drawn to evaluate the etiology of that ketoacidotic state. Normal values are really low below 0.4 millimoles per liter. An increased value, especially if it’s over 3 millimoles per liter, can indicate that we have a ketoacidotic state, whether that be from type one diabetes, alcoholic ketoacidosis, or if someone’s really trying with the keto diet. Decreased value will be in the correction of ketoacidosis. Sometimes, that’s what we’re looking for. That wraps it up on our lesson for BHBs. You all did great. Now, go out your best self today and as always, happy nursing.