The objective of a new study published in Archives of Disease in Childhood was to establish the relationship between serum point-of-care (POC) ketones at triage and moderate-to-severe dehydration based on the validated Gorelick Scales.

This was an unblinded, prospective cohort trial conducted in a pediatric emergency department between April 2016 and February 2017. Patients aged 1 month to 5 years, with vomiting and/or diarrhea and/or decreased intake and signs of moderate or severe dehydration or clinical concern for hypoglycemia were enrolled. The primary outcome was to describe the relationship between triage POC ketones to the two Gorelick Scales. Secondary outcomes were to examine the response of ketone levels to fluid/glucose administration and patient disposition.

Overall, 198 patients were included; the median age was 1.8 years. The median triage ketones were 4.6 mmol/L. A weak correlation was identified between triage ketones and the 10-point Gorelick Scale, however no correlation between triage ketones and the 4-point Gorelick Scale was identified. Those admitted had median triage ketones of 5.2 mmol/L and repeat ketones of 4.6 mmol/L compared to 4.2 mmol/L and 2.9 mmol/L in those discharged home.

Hence, a correlation between triage POC ketones and the 4-point Gorelick Scale could not be established. POC ketones at triage have poor accuracy for predicting hospital admission. The elevated profile of POC ketones in non-diabetic children with acute illness suggests a potential target of tailored treatments for further research.

Source: Archives of Disease in Childhood. 2020 Jul 3;archdischild-2019-318425. doi: 10.1136/archdischild-2019-318425.