Ketones In Urine – Causes, Diagnosis and Treatment

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Ketones are the chemicals your liver makes when the body burns fat for energy. This happens when you have high ketone levels in your body. When your body lacks carbohydrate to produce energy, your body burns fat and proteins to produce energy. 

This is a normal process and produces ketones. They are water-soluble molecules and also act as an alternative fuel when your body doesn’t have enough sugar or glucose as an energy source. The breaking down process of fat is done in the liver, where the fat in your body will turn into fatty acids known as ketones. These chemicals released by the liver go into your bloodstream and act as the fuel to process the body’s metabolism and other functions.

Are ketones dangerous for your body?

It is not a dangerous issue for those without diabetes and for people with diabetes it is dangerous. This may lead diabetic patients to dehydration, several health issues, and change the chemical balance of the blood. The blood of diabetic patients may become more acidic and can lead to a coma or death. The symptoms associated with high ketone levels are:

  • Unquenchable thirst
  • Frequent urination
  • Dry mouth
  • High blood sugar levels
  • Fatigue
  • Nausea
  • Dry skin
  • Abdominal pain
  • Difficulty in breathing

What are the causes of ketones in the urine?

The main causes of ketones in urine include:


Poorly controlled diabetes

The high level of ketones in the bloodstream is a common cause for diabetes and it may even lead to ketoacidosis when left untreated. Ketonuria is a condition that occurs when a high level of ketone bodies are formed in the bloodstream. It can be dangerous if ketone levels become high and need to be treated carefully among people with diabetes and who are prone to high blood glucose levels. For anyone suffering from type 1 diabetes, their body will start to produce ketones if it has too little insulin for a significant period of time. In this situation, their body breaks down tissues into ketones as it doesn’t have sufficient insulin to get energy. High levels of ketones and hyperglycemia together can make dangerous medical conditions. The symptoms associated with high levels of ketones and poorly controlled diabetes are:

  • Thirst
  • Regular urination
  • Nausea
  • Dehydration
  • Dilated pupils
  • Nausea



Even though excess ketones are commonly seen in people with type 1 diabetes, it can be a problem for people without diabetes too. People without diabetes can also have ketones in the urine if their body is using fat for energy instead of glucose. Low carbohydrate diets or starvation produces more ketones. In this case, the body uses fat for energy because there is not enough glucose. Ketones due to starvation develop quickly in children than in adults.


Anorexia nervosa

Anorexia nervosa is a serious condition due to self-starvation and compulsive exercises. It is noted that ketones are also generated during extreme exercises. While starving, you intake low carbohydrate. This results in decreased serum insulin and increased serum glucagon. So to maintain fuel, an increase in adipose tissue lipolysis occurs. When fatty acids get mobilized, there is an increase in beta-oxidation in mitochondria. After several chemical reactions, beta-hydroxy acetate and acetoacetate are produced. These acids are referred to as ketone bodies and these reactions mainly occur in the liver.


Alcohol dependency

Your body needs the energy to function properly. To produce this energy, glucose, and insulin acts as fuel. Glucose is obtained through the food you eat and insulin is produced by the pancreas. When you consume alcohol, your pancreas will stop producing insulin. But without insulin, your body cannot utilize the energy produced by breaking glucose. So to obtain the essential energy, your body starts to burn fat. This process produces ketone bodies and will begin to build up in your bloodstream. Excess alcohol consumption causes malnourishment and vomiting. This leads to starvation which further reduces the production


Ketogenic diet

A ketogenic diet consists of high- fats and low carbohydrates. So when the body is deprived of carbohydrates due to reduced intake, insulin secretion is significantly reduced and the body enters into a catabolic state. Ketone bodies are produced as a result of this catabolic state. This can be easily utilized for energy production by heart, muscle tissue, and the kidneys. The side-effects of the ketogenic diet include nausea, vomiting, headache, fatigue, dizziness, insomnia, and constipation.

Diagnosis and treatment

A blood test or urine test check for ketones in the urine. Generally, a blood test is preferred as the blood ketone testing equipment is available for home use. Doctors also recommend a blood test rather than a urine test. Because ketones enter the bloodstream first and then travel to the urine, ketones can be measured earlier in the blood. The three types of ketones are acetoacetic acid, acetone, and beta-hydroxybutyric (b-OHB) acid. Among these Urine ketone strips measure only acetoacetic acid and acetone, while blood ketone tests measure b-OHB.

The home meters that are used to measure ketones in the blood are Nova Diabetes Care’s Nova Max Plus and CardioChek. But these test strips are costly than urine ketone strips, and it requires a meter that can check for blood ketones. But urine ketone test can be done by dipping a reagent strip in urine, urinating on the strip, or, in the case of very young children, pressing the strip against a wet diaper. The colors on the strip are compared to a color chart on the container to determine the amount of ketones present. You should conduct ketone tests in the following situations.

  • If you have a blood glucose level over 250 mg/dl
  • If you have a cold, a sore throat, the flu, a stomach virus, suspected food poisoning, or anything else that makes you feel ill
  • Experiencing increased urination, a stomachache, and dry mouth
  • If you have experienced a traumatic stress
  • If you are pregnant

The treatment for this issue includes drinking plenty of water or other calorie-free fluids to help flush ketones out of the body, taking insulin to bring your blood glucose level down, and rechecking both your blood glucose level and ketone level every three to four hours. If ketones are present, additional insulin should be injected into your body to normalize the ketone level.

What should you do if you have ketones?

If you have ketones, then you must drink 8 ounces of water or carb/caffeine-free beverage every 30-60 minutes to help flush out the ketones. If your body needs more insulin, then you should have an insulin dosing plan. This generally occurs when an illness is present, your body releases hormones in response to the stress. These hormones lead to an increase in blood glucose levels. That is why it is recommended to test ketone levels during illness. If you have type 1 diabetes, you need a ketone test. Because, in this type of diabetes, your immune system attacks and destroys cells in your pancreas that make insulin. Thus the blood sugar level rises. Those with type 2 diabetes also have ketones but are not common like type 1 diabetes.

Importance of drinking water in a keto diet

Drinking lots of water is very important for every diet that you follow. Keto diet is a low-carb diet and water has a significant role in it. Drinking more water following ketogenic diet will help you to overcome the main side effects of low carb diet, which is dehydration. This is because carbohydrates are responsible for holding water and sodium in your body. When you restrict the intake of carbs, they are excreted, which means you retain less water. This means people following the keto diet need to drink more water compared to other diets. If you are not drinking enough water, then you will have mild dehydration can lead to headaches, fatigue, dry mouth, and flu-like symptoms. This deters you from getting the results you’re after on the ketogenic diet and lead to long-term health problems.

High level of ketones in the bloodstream can be dangerous when left untreated. It can lead to serious and life-threatening diabetic coma or death. High levels of ketones are toxic to the body too and if you’re experiencing these, you should seek out medical attention.

Dr. David J Thoreau is a Health professional born and bought up in Australia. He is a trained cardiologist and a passionate blogger too. David got involved in the medical field as a heart specialist at the start of 2000. But he never gave up on his passion and dedicated some time to study all the pieces of blogging along with the profession. Now he decided to devote the rest of his life to blogging. So he teamed up with the medical counsel, a complete and genuine health-related blog.

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