Beta-Hydroxybutyrate

Overview

Beta-hydroxybutyrate (βHB) is the primary ketone body produced during ketogenesis in the liver, measuring the level of this molecule in blood as an indicator of ketosis or ketoacidosis. It serves as an alternative energy source for tissues like the brain during carbohydrate deprivation or metabolic stress. Elevated levels indicate diabetic ketoacidosis (DKA), alcoholic ketoacidosis, starvation ketosis, or ketogenic diet compliance, while low levels are normal in fed states. It is clinically useful for confirming ketosis over urine ketones and guiding DKA management.

Clinical Use Cases

  • Diagnosing and monitoring diabetic ketoacidosis.
  • Assessing alcoholic or starvation ketoacidosis.
  • Monitoring ketogenic diet adherence or therapeutic ketosis.
  • Differentiating ketoacidosis from other causes of metabolic acidosis.

Specimen Types

  • Plasma (preferred, lithium heparin).
  • Serum.
  • Whole blood (point-of-care meters).

Measurement Methods

  • Enzymatic assay (kinetic UV or colorimetric).
  • Point-of-care reflectance meters.
  • Liquid chromatography-mass spectrometry (LC-MS/MS).

Test Preparation and Influencing Factors

  • No fasting required; test during suspected ketosis.
  • Insulin therapy rapidly lowers levels in DKA.
  • Recent carbohydrate intake suppresses production.
  • Hemolysis or prolonged storage may falsely elevate results.

Synonyms

  • β-Hydroxybutyrate.
  • β-OHB.
  • 3-Hydroxybutyrate.

Further Reading

  • Beta-hydroxybutyrate Test; MedlinePlus;