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What is Ketone bodies in urine test?

Glucose is the primary source of energy for human body. It is transported to every cell of the body through a hormone called insulin. However, diabetic people, who have impaired or low insulin, cannot properly utilise glucose for energy production. Hence, their body starts to break down fats as an alternative source of energy.

Ketones are the breakdown products of fats. They are normally present in low amount in the urine. The presence of excess ketones in the urine leads to a condition called ketonuria. High levels of ketones in the body (Ketoacidosis) can result in serious illnesses or even death. 

A ketone bodies urine test is used to check the amount of ketones that your body is releasing in urine. This test is assistive in the diagnosis of diabetes mellitus. 

Ketone levels in the body also go up in conditions of fasting and starvation. So, this test is also used for evaluating these conditions. 

The alternative names of the test are ketones urine test, urine ketones, ketone bodies and ketone test.

  1. Why is Ketone bodies in urine test performed?
  2. How do you prepare for a Ketone bodies in urine test?
  3. How is a Ketone bodies in urine test performed?
  4. What do Ketone bodies in urine test results mean?

Your healthcare practitioner may advise you to undergo this test if you have diabetes. Excess ketones in body due to diabetes - diabetic ketoacidosis (DKA) - can be life-threatening, if not treated quickly. DKA more prominently occurs in individuals with type 1 diabetes than type 2 diabetes. Ketone bodies in urine test is used for the diagnosis of DKA.

You may need to undergo this test if you have diabetes and show the following symptoms:

You may also be asked to get this test if your blood glucose level is greater than 240 mg/dL.

If you have diabetes, the following conditions may alleviate ketone levels in your body:

Apart from diabetes, the following conditions can cause ketoacidosis:

  • Alcoholism
  • Starvation
  • Isopropanol ingestion
  • Fasting
  • High-protein diet
  • Acute febrile illnesses (fever of 38°C or higher), especially in infants and children
  • Pregnancy
  • Extreme exercise
  • Eating disorders 
  • Chronic vomiting 
  • Low carbohydrate diets

You may need to fast before this test. Tell your healthcare practitioner if you take any herbs, supplements, vitamins, medicines (including over-the-counter medications) or illicit drugs. The following drugs may lead to false-positive results:

  • Isoniazid
  • Phenazopyridine
  • Phenolsulphonphthalein
  • Bromosulphophthalein
  • Levodopa
  • Phenothiazines such as acetophenazine, triflupromazine and so on

A clean catch method is used to collect a urine sample for this test. You will be provided with a special container to collect the sample. Here is the right way for sample collection:

  • Wash your hands properly.
  • Clean your private parts. Women should open their labia and clean the area from front to back; men should wipe the tip of the penis.
  • Let the first few drops of urine to flow out into the toilet bowl as you start urinating. Then, collect a midstream sample in the container - the container will have a mark to tell you how much sample is needed. In a mid-stream urine sample, you are not supposed to collect the first or last part of urine; since it reduces the possibility of contaminating the urine sample with bacteria from your hands or the urethra, a tube that carries urine out of your body.
  • Close the container and wash your hands.

The test result may vary depending on your age, sex, diet, activity level, health history and other factors.

Normal results:

Normal test results are expressed as negative.

Abnormal results:

Abnormal results mean that you have high levels of ketones in your urine. It can be classified as follows:

  • Small: <20 mg/dL
  • Moderate: 30-40 mg/dL
  • Large: >80 mg/dL

An abnormal result may indicate the following conditions:

  • Diabetes mellitus
  • Alcoholism
  • Fasting
  • High-protein diet
  • Post-anaesthesia
  • Starvation
  • Anorexia, a mental illness in which a person does not eat/eats too less
  • Vomiting
  • Diarrhoea
  • Fever
  • Hyperthyroidism (overproduction of thyroid hormones)
  • Pregnancy

The following conditions may affect the test results:

  • Diets low in carbohydrates and high in fats and proteins
  • Loss of ketones in the air when the urine sample stands for too long.
  • Exercising strenuously

Discuss with your healthcare provider about what the test results mean for you.

Disclaimer: All results must be clinically correlated with the patient’s complaints to make a complete and accurate diagnosis. The above information is provided from a purely educational point of view and is in no way a substitute for medical advice by a qualified doctor.

References

  1. Benioff Children's Hospital [internet]. University of California. San Francisco. US; Ketones — Urine
  2. US Food and Drug Administration (FDA) [internet]. Maryland. US; Total Carbohydrate
  3. Wilson DD. McGraw-Hill’s Manual of Laboratory & Diagnostic Tests. McGraw-Hill. 2008. Urinalysis; p.589-90.
  4. University of Rochester Medical Center [Internet]. Rochester (NY): University of Rochester Medical Center; Ketone Bodies (Urine)
  5. Hinkle J, Cheever K. Brunner & Suddarth's Handbook of Laboratory and Diagnostic Tests. 2nd Ed. Philadelphia: Wolters Kluwer Health, Lippincott Williams & Wilkins; c2014. Ketones: Urine; p. 351.
  6. National Institute of Diabetes and Digestive and Kidney Diseases [internet]: US Department of Health and Human Services; Managing Diabetes
  7. Johns Hopkins Medicine [Internet]. The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System; Urinalysis
  8. American Diabetes Association [internet]. Arlington. Virginia. US; DKA (Ketoacidosis) & Ketones
  9. Joslin Diabetes Center [Internet]. Harvard Medical School. Massachusetts. US; Diabetes Education.
  10. Paoli Antonio. Ketogenic Diet for Obesity: Friend or Foe?. Int J Environ Res Public Health. 2014 Feb; 11(2): 2092–2107. PMID: 24557522.
  11. UF Health [Internet]. University of Florida Health. Florida. US; Ketones urine test
  12. National Health Service [internet]. UK; Diabetic ketoacidosis
  13. Pagana KD, Pagana TJ, Pagana TN. Mosby’s Diagnostic Laboratory Test Reference. 14th ed. Missouri: Elsevier; 2019. Routine urine testing; p.935.
  14. Lorenzi OD, Gregory CJ, Santiago LM, et al. Acute febrile illness surveillance in a tertiary hospital emergency department: comparison of influenza and dengue virus infections. Am J Trop Med Hyg. 2013;88(3):472–480. PMID: 23382160.
  15. Robinson HL, Barrett HL, Foxcroft K, Callaway LK, Dekker Nitert M. Prevalence of maternal urinary ketones in pregnancy in overweight and obese women. Obstet Med. 2018;11(2):79–82. PMID: 29997690.
  16. National Health Service [internet]. UK; How should I collect and store a pee (urine) sample?
  17. National Institute of Diabetes and Digestive and Kidney Diseases [internet]: US Department of Health and Human Services; Hyperthyroidism (Overactive Thyroid)
  18. Chokhawala K, Stevens L. Antipsychotic Medications. [Updated 2020 Jan 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan

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