Ketone bodies may be detected by the serum and urine nitroprusside test, which is the standard test for ketone detection. While bHB is the predominant ketone present in AKA, acetoacetate is the ketone normally detected by the nitroprusside test. As patients with AKA may have elevated acetoacetate levels, it is important not to develop a false sense of security with a negative or only weakly positive test. As treatment progresses and NAD levels increase, the acetoacetate levels may actually increase and the nitroprusside test will reflect an increasingly positive reaction. This natural progression should be expected and does not indicate a worsening of the patient's condition. The clinical application of this test is thus quite variable. Most authors suggest measuring bHB and acetoacetate levels only if the diagnosis is unclear or other ways are not available to follow the patient's response to therapy. 3

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