Desorption electrospray ionization mass spectrometry (DESI MS) is rapidly becoming a powerful analysis tool for a wide variety of samples in the open air. By combining DESI MS and derivatization, acetone in human blood samples, one of the diabetes mellitus (DM) biomarkers, was rapidly analyzed. Prior to DESI, the plasma sample was first exposed to hydroxylamine hydrochloride and acetone in plasma was derived into fixed oxime. The reactive products were validated by DESI/MS/MS. Quantification was performed in the positive-ion electrospray ionization mode by monitoring of the product ions at m/z 74 for acetone oxime and m/z 116 for 4-methyl-2-pentanone oxime as the internal standard. The limit of detection was of the order of magnitude of 0.10 ppbv and the linear range comprised two decades of concentration, covering the relevant concentration range of acetone in plasma samples. The method has achieved fast, high-throughput analysis of acetone in human plasma with little beforehand preparation and an experiment time of only a few seconds.