Implementing point of care blood ketone testing in the Emergency Department

Background: Rapid and accurate testing of blood ketone levels (BKL) can assist in the assessment of insulin insufficiency and detection of diabetic ketoacidosis (DKA) in the acute care setting. We assessed the potential for introducing point of care measurement of BKL into an Australian emergency department. Methods: After providing informed consent, 72 patients (80 separate presentations) with insulin-requiring diabetes who presented to an emergency department with hyperglycaemia (capillary blood glucose level of ≥10.0. mmol/L) underwent testing for BKL at triage. Staff were guided by a protocol developed for interpretation of elevated BKL ≥ 1.0. mmol/L and subsequent actions. Urine ketones and arterial blood gas testing occurred as usual. Time to testing was recorded for all measures. Results: BKL testing occurred immediately in 91% of the presentations, whereas urine ketones and arterial blood gas testing was uncommon (24% and 15% respectively) and not immediate. Elevated BKL (≥1.0. mmol/L) occurred in 17% of presentations, of whom five were diagnosed with DKA within the Emergency Department. However, testing for BKL decreased over the duration of the study. Patients most frequently tested for BKL were younger (58.59 years) than patients who were not tested (79.5 years) (p= .011). Conclusions: Implementation of point of care BKL testing in the Emergency Department can assist in the detection of significant numbers of patients with insulin insufficiency, however, ongoing education and support is required to sustain the change in practice.