Ketonuria happens when you have high levels of ketones in your urine. It is commonly seen in people with diabetes. It can also happen during pregnancy.
Here is what you need to know about ketonuria, along with its causes, symptoms, and treatment.
What Are Ketones?
Ketones, or ketone bodies, are acidic molecules made in your liver. When the liver needs to break down fats to give you energy, it makes ketones as byproducts.
Your body uses ketones for energy when it doesn’t have enough glucose. Glucose is the body's primary energy source, which comes from carbohydrates. Ketones in your urine indicate your body is using fat for energy rather than glucose. Normally, very small amounts of ketones are released as waste in your urine.
If you are fasting or have health conditions such as diabetes, your body makes more ketones than it can use. This increases the levels of ketone bodies in your liver. Your body tries to get rid of them when you pee, resulting in high ketone levels in urine, or ketonuria, which is also known as ketoaciduria or acetonuria.
High ketone levels in your body can cause an increase in acid buildup in your blood. This is called ketoacidosis, which can be harmful.
Ketonuria vs. Ketonemia
Ketonuria is the presence of ketones in your urine. Ketonemia refers to the presence of ketones in your blood. For people with diabetes who have high ketone levels in their blood, urine, or both, it can indicate ketoacidosis — life-threatening levels of acid in your body. High ketone levels in your blood or urine mean you need immediate medical attention.
Causes of Ketonuria
You can develop ketones in your urine because of:
The keto diet. Ketonuria is common in people who follow the keto diet. The ketogenic diet is a low-carbohydrate, high-fat weight-loss plan. This low-calorie diet makes your body use fats and protein as fuel, resulting in ketone formation and excretion.
Fasting. Fasting for long periods or the intermittent fasting diet can lead to ketonuria. During fasting, your liver starts to use up fat and protein reserves in your body to keep it going. This causes ketone formation.
Diuretics. These types of medicines remove excess fluid from your body. They can lead to dehydration, which can produce a buildup of ketones in your urine.
Diabetes mellitus. When your body has low insulin levels, your cells can’t store or use glucose for energy. This results in high blood sugar or diabetes. Your body is left with no option but to break down fats and proteins for energy. This results in the formation of ketone bodies as waste products. These ketones pile up in your body and can even enter your blood, causing diabetic ketoacidosis.
Ketonuria is common in people with diabetes, as their body tries to remove excess ketones through urine.
Renal glycosuria. This is a rare health condition that makes your body release glucose through urine. It happens when the tubules in your kidney don’t function properly. Renal glycosuria lowers your sugar levels. This causes your liver to burn fats and protein for energy, which results in ketonuria.
Glycogen storage disease. Your body stores glucose as glycogen as an energy source. When glycogen can’t be stored properly, you can develop this metabolic disease. It forces your liver to use sources other than glycogen for energy. This causes ketones to be expelled through your urine.
Too much alcohol. Binge or heavy drinking can leave you dehydrated or malnourished if you don't drink water or eat regularly or if you are throwing up a lot. This may cause your body to start making ketones, resulting in a condition called alcoholic ketoacidosis.
Drug use. If you have diabetes, using illicit or recreational drugs can put you at risk for diabetic ketosis and diabetic ketoacidosis.
Continuous exercise. Intense exercise can deplete your body's stored glucose. Your body begins breaking down fat for energy, which can produce ketones in your urine.
Pregnancy. Hormonal changes during pregnancy may interfere with your body's ability to process insulin. Ketones in your urine during pregnancy may indicate a blood sugar imbalance from eating too few carbohydrates or gestational diabetes.
Starvation and eating disorders. Your body can use up its reserve of glucose in a few days of fasting. Your muscles begin to break down, releasing fatty and amino acids into your blood, increasing the likelihood of ketones in your urine.
Illness or stress. Hormones such as cortisol (your stress hormone) and epinephrine (adrenaline) can affect blood sugar levels. When you have too much of these hormones, it can make your insulin levels fall and your liver less capable of regulating your blood sugar. Stress can increase your risk for diabetes. If you are seriously ill or under a lot of stress, doctors advise checking your urine for ketones.
Heart surgery. Ketonuria can also develop in people who have heart procedures such as bypass surgery.
Corticosteroids. These medications can interfere with your cellular insulin response, lower your blood sugar, and increase ketone production.
Ketonuria Symptoms
Ketonuria often follows or causes ketoacidosis. High levels of ketones in your body can be dangerous.
Symptoms you must look for include:
- Thirst and dehydration
- Electrolyte imbalances
- Fruity-smelling breath
- Tiredness and confusion
- Vomiting
- Frequent peeing
- Heavy breathing
Diagnosis of Ketonuria
Doctors can find out if you have ketonuria by checking for symptoms and through blood and urine tests.
Some commonly used tests to check for ketones include:
- Blood test to check sugar levels
- Urine strip test with agents that change color when they react with ketones
- Breath test to check for the fruity smell of acetone
- Enzyme assays to measure ketone levels
- Home tests using blood glucose monitoring devices
Additional tests you might take include:
- Blood electrolyte tests
- Chest X-ray
- EKG
- Complete blood count (CBC)
- Urinalysis
- Arterial blood gas
- CT scan
- Kidney function test
Ketone Testing
You can test for ketones through your blood or urine. There are advantages and disadvantages to both methods.
Urine test strips. Drug and retail stores have several types of urine test strips for ketones available for over-the-counter purchases. They are easy to use and carry with you. However, the results can "lag," meaning they show ketone levels that may be several hours old. Also, the results can be off if you're dehydrated.
To use:
- Pee on the test strip or dip it in your urine.
- Remove the test strip and wait for the time described for your test strip.
- Compare the color on the test strip to the color chart provided to see if you have ketones present and at what level.
Blood test meters. You'll need a blood glucose meter that also checks for ketones such as Abbot Precision Xtra and Nova Max Plus. Blood ketone tests tend to be more accurate and reflect your levels at the time you take the test. However, this is an expensive test method, and the meter may not be covered by your insurance.
Use this test as you'd use a blood glucose meter:
- Put a test strip in the meter.
- Prick your finger with the lancing device.
- Place a drop of your blood on the ketone strip and wait for the result.
Ketone level results
Use this chart to determine when your ketone levels are high enough to take action.
| Reading | Ketone level | What to do |
|---|---|---|
| Fewer than 0.6 millimoles per liter (mmol/L) | Normal | Nothing |
| 0.6 to 1.5 mmol/L | Low to moderate | Contact your doctor |
| 1.6 to 2.9 mmol/L | High | Go to the ER |
| 3.0 mmol/L or greater | Very high | Go to the ER |
Ketonuria Treatment
Ketonuria caused by fasting or diet doesn’t require treatment and will resolve on its own. But when it happens due to an underlying condition, it is a serious concern.
- Ketonuria in people with diabetes is treated using insulin injections or intravenous (IV) drips.
- When caused by other illnesses, ketonuria can be treated using the appropriate diet, medication, or therapy for the condition.
Ketonuria caused by excessive alcohol use is treated in the following ways:
- Administering IV fluids
- Electrolyte monitoring and replacement
- Thiamine
- Glucose, if needed
- Medications to avoid severe effects of alcohol withdrawal
- Medications to prevent nausea and vomiting
Treatment for patients who have ketonuria due to starvation is similar to that for those with alcohol use disorder. However, doctors may treat patients with starvation somewhat differently due to the risk of a complication called refeeding syndrome — a cluster of dangerous symptoms caused by too few electrolytes, which can happen when your body tries to process nutrients again after starvation.
Complications of Ketonuria
Ketoacidosis
Ketoacidosis happens when your body is unable to use sugar to produce energy, leading it to break down fat for fuel instead. For people with diabetes, ketoacidosis can develop rapidly, so it's important to recognize the symptoms and act quickly.
Call your doctor immediately if:
- Your blood sugar is consistently higher than your target range.
- You have moderate or high levels of ketones in your urine.
- You can't stop throwing up.
Dehydration
Dehydration means your body doesn't contain enough water to function properly. Dehydration is one of the symptoms of ketoacidosis and is characterized in adults by:
- Dark-colored urine
- Dizziness, weakness, and fatigue
- Headache
- Confusion or delirium
- Dry mouth or a dry cough
- Rapid heart rate along with low blood pressure
- Flushing
- Muscle cramps and swollen feet
- Constipation and loss of appetite
Pregnancy complications
Pregnancy increases your resistance to insulin, particularly in the second and third trimesters. It's the hormonal changes in pregnancy that trigger this resistance. If you already have diabetes or have been diagnosed with gestational diabetes, ketones in urine may develop more rapidly and at lower blood glucose levels than in those who are not pregnant. Frequent vomiting during pregnancy or drinking fewer fluids, especially in the last trimester, can also produce high levels of ketones in urine.
Prevention of Ketonuria
If you have diabetes, it is important to control your blood sugar levels. Closely monitor your blood glucose levels and check for symptoms to prevent ketonuria and complications that can happen because of it.
To keep your blood sugar levels in check, eat foods such as leafy and non-starchy vegetables, nuts and seeds, berries, whole grains, and healthy fats. Balance the amount of carbs you eat with an equal portion of proteins in the form of meat, fish, eggs, cheese, and tofu. That's because proteins slow down the intake of glucose into the blood to help your blood sugar levels stay within a normal range.
Takeaways
The presence of ketones (acids) in your urine means that your body is using fat for energy instead of its normal glucose (sugar). High amounts of ketones in your urine are dangerous and can lead to a condition called ketonuria. It can affect people with diabetes, or those who are pregnant, have an eating disorder, or are heavy alcohol users. You can measure ketones in your urine using over-the-counter tests available online or at retail drug stores. Or your doctor can do a test called a urinalysis. It's important to seek medical help right away if your urine shows more than a trace of ketones.
Ketonuria FAQs
How is ketonuria diagnosed?
You can do an at-home test, available from a retail or online pharmacy, to measure ketones in your urine. They are easy to use — you pee on a test trip, wait, and then compare the color it turns to the chart that's provided. Your doctor can also order a urinalysis, a test that detects signs of ketoacidosis, and follow up with a blood ketone test if the urinalysis shows more than trace levels of ketones in your urine.
Can ketonuria be prevented?
If you are at risk for ketonuria, keeping your blood sugar levels under control is a good first step. Taking your medicine as directed is important as well. Keep urine test trips on hand, which are portable and easy to use, to measure ketone levels in your urine.
What lifestyle changes can prevent ketonuria?
Keep your blood sugar levels in check by regularly eating foods such as leafy and non-starchy vegetables, nuts and seeds, berries, whole grains, and healthy fats.
