Ketonuria - An Overview

What Is Ketonuria?

Ketones in the urine is generally seen in uncontrolled diabetes mellitus, fasting, dieting, starvation, and eating disorders. It can also occur during pregnancy. Diabetics prone to ketonuria require regular monitoring of their urine for signs of ketone buildup that can cause various life-threatening symptoms unless treated promptly. Other names for ketonuria are ketoaciduria and acetonuria. Ketones are formed in the liver as a byproduct of fats and proteins. These ketone bodies are used as a source of energy when enough glucose is not present in the body. In cases such as diabetes mellitus, fasting, and other health conditions the body produces a large amount of urine in the kidneys. The increased level of ketones is then excreted in the urine called ketonuria. If the ketone bodies are not excreted in urine it gets buildup in the body. This increase in acid buildup is called ketoacidosis and is harmful to the body.

What Causes Ketonuria?

Fasting - Intermittent fasting diet or fasting for long periods of time can cause ketonuria. During fasting, the liver breaks down fat and protein in the absence of glucose to produce energy. This causes the formation of ketone and ketonuria.

Keto Diet - A ketogenic diet involves limiting or cutting out carbohydrates and eating fats and protein for energy. This low-calorie diet makes the body use protein and fats as fuel to break down and produce energy. This causes ketone formation and excretion.

Diabetes Mellitus - Diabetes mellitus is a condition in which there are low insulin levels in the body. As there is low insulin in the blood the cells cannot store or use glucose for energy. This results in high blood sugar in the blood. The body then uses fats and proteins to break down and produce energy. This forms the ketone bodies. These ketone bodies if not excreted in urine can build up in the blood causing diabetic ketoacidosis.

Renal Glycosuria - It is an abnormal condition that occurs due to improper functioning of the renal tubules causing the release of glucose through urine. It is characterized by low blood sugar levels. This condition causes the liver to burn fats and proteins to produce energy resulting in ketonuria.

Glycogen Storage Disease - In this disease, the liver is forced to use fats and proteins as a source of energy instead of glycogen. Hence leads to the formation of ketone bodies and ketonuria.

Excessive Alcohol Consumption - Excessive intake of alcohol is associated with a lack of sufficient nutrient absorption and a state of chronic starvation. Moreover, the metabolism of ethanol inhibits gluconeogenesis. This causes the production of ketones.

Other causes include the following:

• Heavy strenuous exercise.

• Long-term or intermittent fasting.

• Pregnancy.

• Starvation.

• Hormones such as epinephrine and cortisol.

• Stress and illness.

What Are the Symptoms of Ketonuria?

• Frequent urination.

• Heavy breathing.

• High blood sugar levels.

• Vomiting.

• Fruity-smelling breath.

• Confusion and tiredness.

• Dehydration and thirst.

• Anorexia (eating disorder).

• Breastfeeding.

How Is Ketonuria Diagnosed?

Ketonuria is diagnosed by blood and urine test.

Urinalysis - Before the test, the patient should not consume anything for several hours and must collect the urine specimen in a sterile container and provide it to a doctor for testing. For at-home testing, the laboratory technician can provide the patient urine collection container and a test strip. Both the test strip and the container have a color chart that indicates the ketone level. The patient must not consume anything for several hours before the test. In both circumstances, the ketones in the urine tests will specify whether the levels are minor, moderate, or high. Different factors such as age, gender, medical history, existing medication, diet, and activity level can impact the ketone levels.

Blood Analysis - Ketone bodies appear in the urine and in the blood, so a blood glucose test can be done too. The test is often conducted in a laboratory. However, patients taking insulin can get this test done by a prescription from their doctor for blood glucose test for at-home testing. It is done as follows:

• Follow the instructions on the packaging to place the needle accurately into the lancet pen.

• Place the test lancet against the finger.

• To saturate the strip, press the button and wait until the blood saturates.

• Leave it there until the meter records.

• Wait for some time and record the results.

• Always use an unopened, sterile, non-expired test strip and blood glucose meter for accurate, safe testing.

Recording the Results-

The results from a urine test for ketones will either be negative or more than normal. A negative test result indicates the ketone levels are normal for the individual. A level more than the normal result means the test detected ketones in the urine. The result can be read as follows:

• Less than 20 mg/dL- Mild levels of ketones.

• Between 30 and 40 mg/dL- Moderate levels of ketones.

• Above 80 mg/dL- Large levels of ketones.

And for the blood test, the test results can be classified in three ranges:

• 0.6 mmol/L or below - It is in the normal range.

• 0.6 to 1.5 mmol/L -There are ketones in the blood. Consult a doctor about possible options.

• 1.6 mmol/L or above - This indicates a high risk of acquiring diabetic ketoacidosis. Consultation with a doctor is needed immediately.

As urinalysis only inspects for current or recent ketone levels, a blood test can be more accurate. A high result could be due to other factors as follows:

• High fever or recent illness.

• High protein diet or low carbohydrate diet.

• Eating disorders such as anorexia.

• Excessive alcohol consumption.

• Overproduction of the thyroid hormone.

• If a patient is not sure about their results, they should contact a specialist to analyze the results, mostly for at-home testing.

Conclusion

Ketonuria is caused by fasting or diet, diabetes mellitus, keto diet, and starvation. It is a serious problem when it occurs due to an underlying condition. Ketonuria in diabetics is treated using insulin injections or intravenous (IV) drips. When yielded by other illnesses, ketonuria can be treated using medication, an appropriate diet, and therapy for the condition. Diabetes needs good control over blood sugar levels. Closely monitoring blood glucose levels and checking for symptoms is necessary to prevent ketonuria and complications that can arise because of it.