Ketones in Urine (Ketonuria)

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Ketones in urine (ketonuria) and Ketones in urine test

May 23, 2021 by Anupama Sapkota
Table of Contents 
What are ketones?
What are ketone bodies?
What is Ketonuria
What are the causes of ketonuria?
What are the symptoms of ketonuria?
Ketones in urine test
Objectives of ketone in urine test
Principle of ketone in urine test
The procedure of ketone in urine test
Result and Interpretation of ketone in urine test
Uses of ketone in urine test
Limitations of ketone in urine test
References
Internet Sources
What are ketones?

Chemically, ketones are the organic compounds containing carbon,
oxygen various carbon-containing substituents.
Ketones consist of a carbonyl (C=O) functional group.
In our body, ketones are the metabolic end products of fatty acid
metabolism.
What are ketone bodies?

Ketone bodies are the water-soluble particles formed in the liver when
the acetyl-CoA formed in the liver during the oxidation of fatty acids
undergoes ketogenesis instead of entering the citric acid cycle when
carbohydrate is not available or poorly utilized.
Ketone bodies are produced in the liver and are used as an energy
source when glucose is not readily available.
The two main ketone bodies are acetoacetate (AcAc) and 3-beta-
hydroxybutyrate (3HB), while acetone is the third, and least abundant,
ketone body.
AcAc accumulates during fatty acid metabolism under low
carbohydrate conditions.
3-β-hydroxybutyrate is formed from the reduction of AcAc in the
mitochondria.
Acetone is generated by spontaneous decarboxylation of AcAc and is
responsible for the sweet odor on the breath of individuals with
ketoacidosis.
During periods of glucose deficiency, ketone bodies play a crucial role
in sparing glucose utilization and reducing proteolysis.
What is Ketonuria
The medical condition associated with the excretion of more than
usual quantities of the ketone bodies in the urine is called ketonuria.
This usually occurs as a result of the utilization of ketone bodies as a
source of energy.
Under the reasonable condition, the body utilizes carbohydrates as a
source of energy, and the ketones formed in the liver are almost
entirely metabolized. Thus, the only negligible amount of ketones are
observed in the urine.
However, when the carbohydrates are unavailable, fat functions as the
predominant fuel and results in the formation of a large number of
ketones as a by-product.
It is seen during starvation or more commonly in type 1 diabetes
mellitus.
Overproduction of ketone bodies in uncontrolled diabetes or severely
reduced calorie intake can lead to acidosis or ketosis (severe
condition).
What are the causes of ketonuria?

The following are the primary causes of ketonuria:
Low Insulin levels
Insulin helps maintain the blood sugar level in the body by signaling
the liver, muscle, and fat cells to release sugar to maintain the level in
the blood.
Alternately, when the blood level is sufficient, insulin signals the liver
to take up glucose and store it as glycogen.
When the level of insulin is low in the body, the body cannot efficiently
move sugar into cells or store it as fuel in the liver. Instead, the body
fat and proteins are utilized, which causes the release of a large
number of ketones as by-products.
Metabolic abnormalities such as diabetes mellitus, renal glycosuria,
or glycogen storage disease which are associated with low insulin
levels, serve as a cause for ketonuria.
Dietary conditions like ketogenic diet or starvation
A low carbohydrate diet, ketogenic diet, might also be a cause of

ketonuria.
Under this diet, people tend to consume a diet with low
carbohydrates, which causes the body to utilize available fats and
protein, resulting in the release of ketones as a by-product.
Similarly, during starvation, the insulin level in the body decreases as
a result of a lack of food consumption.
Once the reserved glucose is utilized, the body starts feeding on the
protein and fat present in the body, creating ketone bodies as an
alternative fuel source.
Pregnancy
The change in the pregnancy hormone prevents the consumption of

glucose by body cells, leading to a sugar deficiency.
As a result of low carbohydrates, metabolism of fats and protein is
initiated.
Digestive disturbances
Because of some disturbances in the digestive system, if the

absorption of carbohydrates is compromised, the body glucose level
might decrease.
The body then utilizes the muscles and fats to produce the necessary
energy causing a rise in the levels of ketone bodies in the urine.
Prolonged alcohol consumption
Heavy alcohol intake, usually in the setting of poor nutrition results in

depleted hepatic glycogen stores, and ethanol metabolism further
impairs gluconeogenesis.
Strenuous exercise
Excessive vomiting and diarrhea
What are the symptoms of ketonuria?

The symptoms of ketonuria depend on the underlying cause.
However, ketonuria might also be a symptom of ketoacidosis
The common symptoms associated with ketonuria are the following:
Fruity smelling breath
This results because of the fruity odor of acetone which is released

from the lungs.
Frequent urination
The tendency to urinate occurs more often than usual as the body
tries to get rid of ketone bodies.
Nausea and vomiting

As a result of the increased level of ketone bodies in the body,
disturbance might be created in other electrolytes like sodium and
potassium.
Change in the level of these electrolytes can lead to nausea and
vomiting
Dehydration and excessive thirst
Frequent urination, nausea, and vomiting lead to dehydration and

excessive thirst.
Heavy breathing
Confusion and disorientation
Prolonged ketonuria might affect the brain resulting in a lack of focus

and confusion.
Image Source: Everyday Health
Ketones in urine test

The detection of ketones in the urine is a simple process that can be
performed through a urine dipstick called the ketone in the urine test.
Objectives of ketone in urine test

The objective of the test is to detect the presence of ketone bodies in
the urine.
The results from the ketones in urine tests can vary from quantitative
with a specific number to qualitative as a small, moderate, or a large
amount of ketones.
Principle of ketone in urine test

The ketone in the urine test detects acetoacetic acid and acetone in
the urine.
The principle of the ketone in the urine test is that the keto-group of
acetone and acetoacetic acid reacts with alkaline nitroprusside to
form a purple-colored complex.
Based on the intensity of the color, the quantitative or qualitative
analysis of ketone in urine can be done.
The procedure of ketone in urine test

1. Before the sample collection, hands should be washed.
2. Then the genital area is cleaned with a cleansing pad. In the case of
men, the tip of the penis is wiped. In the case of women, labia should
be cleaned from front to back.
3. At least an ounce or two of urine is then collected into the container,
which should have markings to indicate the amount.
4. One of the urine dipsticks is taken and is dipped in the container.
5. The strip is taken out and dried by shaking lightly.
6. The color of the strip is observed once the strip is dry.
Result and Interpretation of ketone in urine test
Image Source: The Diabetes Council
The color observed in the strip is then tallied against the chart that
comes with the test kit.
Based on the intensity of the purple color, the quantitative analysis of
the ketone bodies can be done.
In the case of qualitative analysis the following, the concentration can
be detected as follows:
Small: 20 mg/dl
Moderate: 30 to 40 mg/dl
Large: >80 mg/dl
Uses of ketone in urine test

This test is usually used to monitor people at a higher risk of
developing ketones in urine like people with type 1 or type 2 diabetes.
The detection of ketone bodies in urine is essential as the presence of
ketones in urine can be a symptom of a more severe condition like
toxic ketoacidosis.
Limitations of ketone in urine test

Because of the imbalance between the concentration of acetone and
β-hydroxybutyrate, the number of ketones measured in the urine
cannot be considered as the total plasma ketone
The ketone in the urine test only detects acetoacetic acid and not β-
hydroxybutyrate.
The ketone strips usually have a short shelf life.
Interference by other substances like vitamin C might give inaccurate
results.
References
Kumar V., Gill K.D. (2018) Qualitative Analysis of Ketone Bodies in
Urine. In: Basic Concepts in Clinical Biochemistry: A Practical Guide.
Springer, Singapore.
Nelson, and Michael M. Cox (2000) Lehninger Principles of
Biochemistry. New York: Worth Publishers..
Dhatariya K. (2016). Blood Ketones: Measurement, Interpretation,
Limitations, and Utility in the Management of Diabetic
Ketoacidosis. The review of diabetic studies: RDS, 13(4), 217–225.
https://doi.org/10.1900/RDS.2016.13.217
Laffel L (1999). Ketone Bodies: a Review of Physiology,
Pathophysiology, and Application of Monitoring to Diabetes. Diabetes
Metab Res Rev. 1999; 15: 412-426.
https://www.belmarrahealth.com/ketonuria-causes-symptoms-
diagnosis-treatment/
https://medlineplus.gov/lab-tests/ketones-in-urine/
Internet Sources
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DMRR72%3E3.0.CO%3B2-8
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DMRR72%3E3.0.CO%3B2-8
2% – https://en.wikipedia.org/wiki/Alcoholic_ketoacidosis
1% – https://www.webmd.com/urinary-incontinence-oab/frequent-
urination-causes-and-treatments
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laboratory/ketone-bodies-urine-test/
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1% – https://medlineplus.gov/lab-tests/ketones-in-urine/
1% – https://en.wikipedia.org/wiki/Starvation_response
1% – https://en.wikipedia.org/wiki/Ketonuria
1% – https://diabetestalk.net/ketosis/ketone-bodies-synthesis
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<1% – https://www.sciencedirect.com/topics/biochemistry-genetics-
and-molecular-biology/ketone-bodies
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Menu Search Notes

Ketones in urine (ketonuria) and Ketones in urine test

What are ketones?

What are ketone bodies?

What are the causes of ketonuria?

Low Insulin levels

Dietary conditions like ketogenic diet or starvation

A low carbohydrate diet, ketogenic diet, might also be a cause of

The change in the pregnancy hormone prevents the consumption of

Because of some disturbances in the digestive system, if the

Prolonged alcohol consumption

Heavy alcohol intake, usually in the setting of poor nutrition results in

Excessive vomiting and diarrhea

What are the symptoms of ketonuria?

Fruity smelling breath

This results because of the fruity odor of acetone which is released

Nausea and vomiting

Dehydration and excessive thirst

Frequent urination, nausea, and vomiting lead to dehydration and

Confusion and disorientation

Prolonged ketonuria might affect the brain resulting in a lack of focus

Image Source: Everyday Health

Ketones in urine test

Objectives of ketone in urine test

Principle of ketone in urine test

The procedure of ketone in urine test

Result and Interpretation of ketone in urine test

Image Source: The Diabetes Council

Large: >80 mg/dl

Uses of ketone in urine test

Limitations of ketone in urine test

Read Also ...

Biochemistry, Laboratory Tests

Read Also (Related Notes)

Disclaimer (Terms and Conditions)

© 2021 Microbe Notes. Made with ♡ by Sagar Aryal.

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