Test ID: BHYD
Beta-Hydroxybutyrate, Serum
Secondary ID 
A test code used for billing and in test definitions created prior to November 2011
NY State Approved Indicates the status of NY State approval and if the test is orderable for NY State clients.
Useful For Suggests clinical disorders or settings where the test may be helpful
Monitoring therapy for diabetic ketoacidosis
Investigating the differential diagnosis of any patient presenting to the emergency room with hypoglycemia, acidosis, suspected alcohol ingestion, or an unexplained increase in the anion gap
In pediatric patients, the presence or absence of ketonemia/uria is an essential component in the differential diagnosis of inborn errors of metabolism
Serum beta-hydroxybutyrate is a key parameter monitored during controlled 24-hour fasts
Method Name A short description of the method used to perform the test
Photometric, B-Hydroxybutyrate Dehydrogenase (B-HBDH)
Reporting Name A shorter/abbreviated version of the Published Name for a test; an abbreviated test name
Aliases Lists additional common names for a test, as an aid in searching
Beta-Hydroxy Butyric Acid, Serum
Hydroxybutyrate, Beta
Ketone Bodies
Specimen Type Describes the specimen type needed for testing
Specimen Required Defines the optimal specimen. This field describes the type of specimen required to perform the test and the preferred volume to complete testing. The volume allows automated processing, fastest throughput and, when indicated, repeat or reflex testing.
Collection Container/Tube:
Preferred: Serum gel
Acceptable: Red top
Submission Container/Tube: Plastic vial
Specimen Volume: 0.5 mL
Forms: If not ordering electronically, submit a General Request Form (Supply T239) with the specimen.
Specimen Minimum Volume Defines the amount of specimen required to perform an assay once, including instrument and container dead space. Submitting the minimum specimen volume makes it impossible to repeat the test or perform confirmatory or perform reflex testing. In some situations, a minimum specimen volume may result in a QNS (quantity not sufficient) result, requiring a second specimen to be collected.
Reject Due To Identifies specimen types and conditions that may cause the specimen to be rejected
| Hemolysis | Mild OK: Gross reject |
| Lipemia | NA |
| Icterus | NA |
| Other | NA |
Specimen Stability Information Provides a description of the temperatures required to transport a specimen to the laboratory. Alternate acceptable temperature(s) are also included.
| Specimen Type | Temperature | Time |
|---|---|---|
| Serum | Frozen (preferred) | 7 days |
| Refrigerated | 7 days |
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Beta-hydroxybutyrate (BHB) is 1 of 3 sources of ketone bodies. Its relative proportion in the blood (78%) is greater than the other 2 ketone bodies, acetoacetate (20%) and acetone (2%). During carbohydrate deprivation (starvation, digestive disturbances, frequent vomiting), decreased carbohydrate utilization (diabetes mellitus), glycogen storage diseases, and alkalosis, acetoacetate production increases. The increase may exceed the metabolic capacity of the peripheral tissues. As acetoacetate accumulates in the blood, a small amount is converted to acetone by spontaneous decarboxylation. The remaining and greater portion of acetoacetate is converted to BHB.
Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
<0.4 mmol/L
Interpretation Provides information to assist in interpretation of the test results
The beta-hydroxybutyrate (BHB)/acetoacetate ratio is typically between 3:1 and 7:1 in severe ketotic states.
Serum BHB increases in response to fasting, but should not exceed 0.4 mmol/L following an overnight fast (up to 12 hours).
In pediatric patients, a hypo- or hyper-ketotic state (with or without hypoglycemia) may suggest specific groups of metabolic disorders.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
Twenty four-hour fasting tests should not be performed in patients <2 years of age.
Dipstick serum ketone determination using nitroprusside reagent is often used to estimate ketone body status, but that method has inherent problems. The dipstick does not measure beta-hydroxybutyrate, the most abundant of the physiological ketone bodies; the nitroprusside reagent only reacts with acetoacetate and acetone.
Clinical Reference Provides recommendations for further in-depth reading of a clinical nature
1. Tietz Textbook of Clinical Chemistry. Edited by CA Burtis, ER Ashwood. Philadelphia, WB Saunders Co. 1999
2. Vassault A, Bonnefont JP, Specola N, et al: Lactate, pyruvate, and ketone bodies. In Techniques in Diagnostic Human Biochemical Genetics - A Laboratory Manual. Edited by F Hommes. New York, Wiley-Liss, 1991
3. Bonnefont JP, Specola NB, Vassault A, et al: The fasting test in paediatrics: application to the diagnosis of pathological hypo- and hyperketotic states. Eur J Pediatr 1990;150:80-85
Method Description Describes how the test is performed and provides a method-specific reference
D-3-hydroxybutyrate in the presence of NAD is converted to acetoacetate and NADH at pH 8.5 by D-3-hydroxybutyrate dehydrogenase. At this pH the reaction is favored to the right. The NADH is converted to a colored compound using INT and Diaphorase.(Package insert: Stanbio Beta-hydroxybutyrate LiquiColor Procedure No. 2440; DN: RBR.2440.00, 4/16/2002)
Day(s) and Time(s) Test Performed Outlines the days and times the test is performed. This field reflects the day and time the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time required before the test is performed. Some tests are listed as continuously performed, which means assays are performed several times during the day.
Monday through Sunday; Continuously
Analytic Time Defines the amount of time it takes the laboratory to setup and perform the test. This is defined in number of days. The shortest interval of time expressed is "same day/1 day," which means the results may be available the same day that the sample is received in the testing laboratory. One day means results are available 1 day after the sample is received in the laboratory.
Maximum Laboratory Time Defines the maximum time from specimen receipt at Mayo Medical Laboratories until the release of the test result
Specimen Retention Time Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded
Performing Laboratory Location The location of the laboratory that performs the test
Test Classification Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer's instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR), Investigation Use Only (IUO) product, or a Research Use Only (RUO) product.
CPT Code Information Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Medical Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.
82010
LOINC® Code Information Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the result codes returned for this test or profile.
| Result ID | Reporting Name | LOINC Code |
|---|---|---|
| BHYD | Beta-Hydroxybutyrate, S | 6873-4 |
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