BoardsBridgeMonitoring
monitoring
High-impact pattern
Serial Acid-Base & Ketone Monitoring
Trending β-hydroxybutyrate, anion gap, and bicarbonate during DKA, AKA, and perioperative metabolic stress
Serial β-hydroxybutyrate and venous blood gas trending every 1-2 hours guides DKA/AKA insulin titration; resolution requires β-OHB <0.6 mmol/L AND closed anion gap, not normalized glucose.
If you forget
β-hydroxybutyrate > acetoacetate in DKA — measure β-OHB, not urine strips
Board trap
Resident stops insulin when glucose normalizes — wrong. Insulin must continue (with D5) until AG closes and β-OHB <0.6; stopping on euglycemia alone causes DKA relapse.
Key numbers
- β-OHB <0.6 mmol/L = ketonemia resolved
- Anion gap normal ≤12 mEq/L
- Insulin infusion 0.1 U/kg/hr (no bolus)
- Add D5 when glucose <200 mg/dL
- Correct Na+ no faster than 10 mEq/L per 24 h
- K+ <3.3 mEq/L = hold insulin
Reviewed Sep 15, 2026 for clinical accuracy by BoardsBridge Editorial Process
Drill this as a SOE stem →Uri Rozen, MD — Licensed Physician, Israel
Source guidelines: ASA SCA Perioperative TEE 2010 · ASA SCA Perioperative TEE 2010
Re-review cadence: 12 months from reviewed date.
Related on BoardsBridge
Card ID: serial-acid-base-ketones · Path: aba.monitoring.laboratory-trending.serial-acid-base-ketones