All About Ketonuria


Ketonuria occurs when you have high levels of ketone bodies in your urine. It is usually seen in people with diabetes. It can also occur during pregnancy. 

Here’s what you need to know about ketonuria, as well as its causes, symptoms and treatment.

What is Ketonuria?

Ketonuria, as said above,  occurs when you have high levels of ketone bodies in your urine. This condition is also known as ketoaciduria and acetonuria.

Ketones or ketone bodies are types of acids. When fat and protein are burned for energy, your body produces ketone bodies. This is a normal process. However, due to some health conditions and other reasons, it can go into overdrive.

It is most common in people who have diabetes, especially type 1 diabetes. It can also occur in women who are pregnant or breastfeeding.

If ketone levels are elevated for too long, your blood can become acidic. This can damage your health.

Causes of Ketonuria

Ketonuria occurs when fatty acids are moved out of the body’s triglyceride stores in response to inadequate carbohydrate intake or supply. In cases of abnormal carbohydrate metabolism, such as occurs in diabetes, ketone bodies accumulate in the blood (ketonemia) and are excreted in the urine (ketonuria). The accumulation of ketone bodies is often the cause of acidosis and coma in diabetic patients.

Keto diet. This condition is common in people who follow a ketogenic diet. A ketogenic diet involves cutting out and restricting carbohydrates and eating fats and proteins for energy. This low-calorie diet causes your body to use fat and protein as fuel, which leads to the formation and excretion of ketones.‌

Fasting. Prolonged fasting or intermittent fasting diets can lead to ketonuria. During a fast, your liver begins to use the body’s fat and protein reserves to sustain life. This leads to ketone body formation and ketonuria. 

It is also associated with:

  • Starvation
  • Digestive disturbances
  • Dietary imbalance (high fat/low carbohydrate diet)
  • Eclampsia
  • Prolonged vomiting and diarrhea
  • Glycogen storage diseases
  • Severe, sustained exercise
  • Fever
  • Prolonged exposure to cold temperatures

What are the Symptoms of Ketonuria?

Ketonuria may be a sign that you have ketoacidosis or that it is causing ketoacidosis. The higher your ketone level, the more severe your symptoms are and the more dangerous they are. Depending on the severity, signs and symptoms can include:

  • Thirst
  • Regular urination
  • Nausea
  • Dehydration
  • Heavy breathing
  • Dilated pupils
  • Mental confusion (rare)
  • Breath may also smell of fruit

Your doctor may find related signs:

  • high blood sugar
  • significant dehydration
  • electrolyte imbalance

In addition, there may be signs of illnesses such as sepsis, pneumonia and urinary tract infections that can lead to high ketone levels.

Diagnosis of Ketonuria

Your doctor can find out if you have ketonuria by checking your symptoms and using blood and urine tests.

Some common ways 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

How is Ketonuria Treated?

If your ketonuria is due to a temporary fast or change in diet, it will probably resolve on its own. You will not need treatment. Test your ketone levels and your blood sugar, and see your doctor for a follow-up appointment to be sure.

In more severe cases, the treatment of ketonuria is similar to the treatment of diabetic ketoacidosis. You may need to be treated with the following lifesaving treatments:

  • fast-acting insulin
  • IV fluids
  • electrolytes such as sodium, potassium, and chloride

If your ketonuria is due to illness, you may need additional treatment such as:

  • antibiotics
  • antivirals
  • heart procedures

How do I Avoid Ketonuria?

High levels of ketone bodies can be avoided by maintaining good control of blood sugar levels. For those who are insulin dependent, remembering to inject at the right time can help avoid the build-up of ketone bodies.

People at higher risk for ketonuria, such as those with type 1 diabetes, are advised to monitor their blood glucose levels and may also be advised to have a ketone body test.

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