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We describe a one-step assay for total ketone bodies in serum. D-BETA-Hydroxybutyrate is enzymatically oxidized by NAD+ to acetoacetate. This thermodynamically unfavorable reaction is driven to completion by coupling it with the enzymatic reduction of pyruvate by NADH. The acetoacetate so formed, as well as the pre-existing acetoacetate, is quantitatively decarboxylated to acetone in a gas chromatograph and measured directly. Thus by a single measurement for acetone, all three ketone bodies are simultaneously determined. In light of the ubiquity of situations associated with augmented ketone body production, the clinical implications of this approach are extensive.
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