Hydroxybutyrate - plasma

Last updated: Monday, 22, March, 2004

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Item Process

5 mL blood in lithium heparin tube.



Reference Interval

<1.2 mmol/L.


Investigation of the cause, and monitoring, of metabolic acidosis with an increased anion gap; investigation of hypoglycaemia, especially in children.


The main 'ketone' in plasma is 3-hydroxybutyrate. This assay is more reliable than a semiquantitative ketone assay or a quantitative acetoacetate assay, as these may be inappropriately low if there is coexistent lactic acidosis.

Increase in hydroxybutyrate indicates the presence of ketosis eg, diabetes mellitus, fasting (especially children), alcoholism.

In hypoglycaemia, low levels indicate one of the non-ketotic causes of hypoglycaemia (eg, hyper­insulinism).


Bonham JR. Ann Clin Biochem 1993; 30: 238-247.