Ketones are chemicals that are produced when the body breaks down fat for an energy source.
When there are high levels of ketones in your urine, it can mean that you are not getting enough insulin and that you may have diabetes.
There are several symptoms of ketoacidosis, which is a complication caused by high levels of ketones in your blood, that we will detail below.
If you think you may have ketoacidosis, it is important to see your doctor right away. In this article, we will discuss the process of getting a urine test for ketones and how to interpret the results, even if there are only trace amounts.
What are ketones?
Ketones are produced by the liver and are a byproduct of fat metabolism.
When your body breaks down fat for a source of energy, ketones are produced.
Normally, your body uses glucose, also called blood sugar, which it gets from food for energy.
However, when there is not enough insulin, which is a hormone used by your body to convert glucose into energy, or if your body is unable to use insulin properly, ketones can build up in your blood while your blood glucose levels rise.
If this happens, it can lead to a condition called ketoacidosis, which can be serious and even life-threatening.
What causes high levels of ketones in your urine?
If you have diabetes, you may have high ketones in your blood due to lacking insulin, whether it is from a missed shot, a broken insulin pump, uncontrolled diabetes, or other reasons.
There are several other reasons besides diabetes that can also cause high levels of ketones in your urine, which is also called ketonuria, including:
- Starvation or fasting
- Eating a high-fat diet, a low carbohydrate diet such as the ketogenic diet, or other restrictive diet
- Pregnancy
- Infection
- Excessive diarrhea
- Chronic vomiting
- Eating disorders
- Alcohol abuse
- Extreme exercise
- Pneumonia
- Urinary tract infection
- Heart attack
- Stroke
- Fever
- Sepsis, which is also called blood poisoning
- Nursing a child when you are not on a healthy diet or suffer from malnutrition
- Hyperthyroidism, or excessive production of the thyroid hormones
- Burns
Please note that diabetes is the most common cause of ketonuria due to your body not producing enough insulin, which is common in type 1 diabetes, or your cells not reacting to insulin, which is called insulin resistance and is common in type 2 diabetes.
Both types of diabetes can cause your blood sugar level to spike. Talk to your doctor or health care provider if you have ketonuria to determine what is the cause of it.
What are the symptoms of ketones in your urine?
There are a number of common symptoms you may suffer from if you have ketonuria and these include the following:
- Fruity breath odor
- Increased thirst
- Frequent urination
- Nausea
- Vomiting
- Extreme fatigue
- Difficulty breathing
- Stomach pains
- Confusion
If you have any of these symptoms, it is important that you seek medical attention right away as ketoacidosis, which is when your blood becomes too acidic, can develop quickly and can be life-threatening.
Your doctor or health care professional will check your ketone levels and determine any underlying causes for it.
What are the complications caused by ketoacidosis?
If left untreated due to diabetes, diet, or another cause, ketonuria can lead to ketoacidosis, which is when there are high levels of ketones in your blood and it becomes too acidic.
If you have diabetes, this condition is known as diabetic ketoacidosis.
The complications that are caused by ketoacidosis include:
- Coma
- Cerebral edema, which is a fluid buildup in the brain due to swelling and inflammation caused by trauma
- Cardiac arrest, which is also known as a heart attack
- Kidney failure
- Death
When do I need to see a doctor?
If you are experiencing any of the symptoms listed above, it is important that you see your doctor or health care professional right away to check your ketone levels and determine any underlying causes for it.
If you have diabetes, your doctor will also monitor your blood sugar levels closely as ketoacidosis can develop quickly and be life-threatening.
Drink lots of water too and avoid any strenuous activity as this can worsen the condition.
Due to the dire consequences of ketoacidosis, please seek emergency medical attention immediately.
What is the process of getting a ketones in urine test?
A ketones in urine test is also called a ketonuria test and is used to detect high levels of ketones in your urine.
It is usually done if you have diabetes or if you are experiencing any of the symptoms listed above.
The test is simple and only requires that you urinate into a cup so that your health care professional can test the ketone levels in your urine which can be done from your doctor’s office, lab, or even your own home.
Spot tests are available for home use and consist of a paper that changes color after being dipped into a clean container, usually a cup, of urine or held in your urine stream to indicate the level of ketones in your urine via a color chart.
The paper strip test is very similar to a litmus test. If you are testing children still in diapers, you can press the test strips down on the urine in their diapers.
The home test kits are available at most pharmacies and no prescription is required.
Results of the test are usually available within minutes and what is considered healthy is dependent on a number of factors such as age, weight, lifestyle choices, and other factors.
How do I interpret abnormal results of a ketones in urine test?
A normal result will show trace or small amounts of ketones in your urine sample and anything above that is considered abnormal.
If you have diabetes and your ketone levels are high, it is important to seek medical attention right away as ketoacidosis can develop quickly.
If you are not diabetic but are experiencing any of the symptoms listed above, it is also important to seek medical attention as ketonuria can be a sign of another underlying medical condition.
Below are examples of abnormal results:
Small or trace amounts of ketones in your urine
The results if you have low levels of ketones in your urine will be 20 mg/dl (milligrams per deciliter) and these are considered normal.
The trace amounts of ketones mean there are small amounts of ketones in your urine but not enough to indicate ketoacidosis.
However, if you have trace ketones in your urine and are experiencing any of the symptoms listed above, please see your doctor as it could be a sign of another underlying medical condition and your doctor may ask you to retest every few hours.
Moderate amounts of ketones in your urine
Moderate amounts of urine ketones will show results of 30 to 40 mg/dl and are a cause for concern as this could indicate that ketoacidosis is developing.
If you have diabetes and are experiencing any of the symptoms listed above, please seek medical attention right away and do not exercise as it can exacerbate conditions.
Large amounts of ketones in your urine
If you have large or elevated levels of ketones in your urine, the test will show results of over 80 mg/dl and it is a medical emergency as ketoacidosis is developing quickly.
Seek medical attention immediately. Drink lots of water and avoid strenuous activity as it can worsen the condition.
Summary
Ketones in your urine are a sign that your body is using fat for energy instead of glucose and if you have diabetes, it can be a sign that diabetic ketoacidosis is developing.
Symptoms of ketoacidosis include nausea, vomiting, abdominal pain, fruity-smelling breath, and shortness of breath. If you have diabetes and are experiencing any of these symptoms, it is important to seek medical attention right away as ketoacidosis can be life-threatening.
If you are not diabetic but are experiencing any of the symptoms listed above, please see your doctor as it could be a sign of another underlying medical condition.
A ketones in urine test is a simple test that only requires that you urinate into a cup or dip a strip of paper into your urine stream.
Results are available within minutes and trace amounts of ketones in your urine are considered normal while moderate or large amounts are cause for concern and you need to drink water, avoid strenuous exercise, and seek medical care immediately.
If you have any questions, please consult with your doctor, pharmacist, or healthcare provider about a ketones in urine test and whether you need to take one.
References and Sources:
Diabetes Obesity and Metabolism
BMC
MedlinePlus
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Diabetic.org is devoted to producing expert and accurate articles and information for our readers by hiring experts, journalists, medical professionals, and our growing Diabetic.org community. We encourage you to read more about our content, editing, and fact checking methods here. This was fact checked by Jacqueline Hensler and medically reviewed by Dr. Angel Rivera.
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