Ketonic Bodies or Ketonuria in Urine: Symptoms, Causes, Diagnosis, Treatment, Complications and Prevention

Ketones in urine, or ketonuria, as the name suggests, is characterized by the presence of ketones or ketone bodies in the urine.

Ketones build up in the body when fat cells are burned for energy.

This can be a dangerous condition if the ketone amount is very high, particularly in people with diabetes who have high glucose levels.

Carbohydrates, fats, and proteins are metabolized in the body for the generation of energy, which is used for various metabolic and enzymatic processes within cells. As a priority, carbohydrates are always metabolized for energy production. This is followed by the metabolism of fat and protein.

However, in some cases when the body begins to generate high proportions of energy by metabolizing fats or fatty acids, a waste product of this activity accumulates in the body, which is called ketone bodies. This is generally associated with a lack of sugar or carbohydrates in the diet.

These ketones are known to be excreted through the kidneys. Therefore, doctors generally perform urine tests to identify the presence of excessive ketones in the body.

Symptoms of ketonuria

The concentration of ketone bodies in urine under normal conditions is less than 20 mg / dl. However, if this value rises to abnormal levels, it could be indicative of a condition known as ketoacidosis.

Some of the common symptoms of ketonuria are:

Thirst – The body loses excess fluid during increased ketone excretion. This leads to increased thirst.

Frequent urination : the body tries to excrete accumulated ketones, which are associated with an increased need to urinate.

Nausea or vomiting : As the body tries to eliminate excess ketones through the urine, the excretion of salts such as sodium and potassium increases. Low sodium and potassium levels can lead to symptoms such as nausea and vomiting.

Dehydration: Loss of excess fluids from the body through urination and vomiting can lead to dehydration.

Heavy breathing: labored breathing is a symptom associated with high levels of ketones in the blood.

Confusion – This is a rare symptom and is a harmful effect of ketones in the blood and brain.

The symptoms are produced by the accumulation of ketone bodies. Another characteristic symptom of ketonuria is fruity breath. The fruity smell is caused by the presence of acetone. In severe conditions, ketonuria can lead to coma or death.

Since glucose is not converted to energy, the body relies on fat and muscle for energy production. Ketones are produced as a by-product of this process. The ketones produced enter the blood and make it acidic.

These ketone bodies are excreted in the urine. If left untreated, ketone bodies can build up in the blood, leading to hyperglycemia, ketoacidosis, and ketonuria.

When ketone is excreted in the urine, sodium is expelled along with it. Furthermore, ketones can interfere with uric acid excretion, leading to depression and acidosis .

Ketonuria is associated with many conditions such as starvation, dietary imbalance, digestive disorders, eclampsia, prolonged vomiting and diarrhea, glycogen storage diseases, intense and strenuous exercise, fever, pregnancy, lactation, hyperthyroidism, and prolonged exposure to cold temperatures.

Ketone tests are performed with the help of test strips. The strips are dipped into a urine sample and are generally expressed as positive or negative. Ketone tests are important if your blood sugar levels are above 300 mg / dl and you have fruity breath odor.

Shortness of breath, frequent urination, dilated pupils, dry mouth, excessive thirst, nausea, vomiting, abdominal pain, and dry skin are some of the associated symptoms that warrant a ketone test. While preparing for the test, certain medications and supplements should be avoided. The change in the color of the dipstick indicates the presence of ketones in the urine.

Controlling blood sugar levels is the best way to avoid ketonuria. A healthy diet often helps control blood sugar levels. Those who are diabetic must monitor the disease to control ketone levels in the blood.

Lifestyle changes are also essential to control ketone levels in the blood and urine. Avoiding a ketogenic diet is the best way to control ketone buildup.

Main causes and determinants

During digestion, components of food, including carbohydrates, fats, and proteins, are converted into products that can be used by tissues. Glucose is the most important fuel for different activities in cells.

The hormone insulin delivers glucose to different cells and tissues. In the absence of insulin, cells lack glucose to provide energy to tissues, including muscles. Diabetes mellitus is a disease in which the pancreas does not produce enough insulin.

Because of this, an adequate amount of glucose is not delivered to the cells. Therefore, the body tries to produce energy by breaking down muscle and fat.

Ketones are by-products of this breakdown process. Ketone bodies are made up of three components: beta-hydroxybutyric acid, acetoacetic acid, and acetone.

These ketone bodies enter the bloodstream and are eventually excreted through the urine. Acetone is excreted through the lungs, and this process provides a fruity smell to the breath. As ketone bodies mix with the blood, it becomes acidic.

When left untreated, glucose and ketone bodies build up in the blood. As the levels rise, they can develop into a serious illness. As ketones are excreted in the urine, they can also cause the excretion of sodium and potassium along with it.

Ketonuria is also associated with other conditions such as:

Starvation – This is one of the less common causes of ketonuria. During periods of food deprivation, insulin levels drop. During several days of starvation, the brain switches to glucose as the main fuel-supplying agent.

Therefore, the body desperately tries to produce enough energy by relying on fat and muscle, creating ketone bodies as by-products.

Digestive disorders: when the intake and absorption of carbohydrates are adequate, the synthesis of ketones is inhibited in the body. However, when digestive disturbances affect carbohydrate intake or absorption, fat and muscle tissue are used as the main fuel in the body.

The process of converting these components into energy releases ketone bodies as by-products, which accumulate in the blood. The accumulated product is excreted through the urine.

Dietary imbalance : A high-fat or low-carbohydrate diet affects the availability of carbohydrates for energy production in the body. Fats are burned to produce enough energy, leading to the accumulation of ketones in the blood. The accumulated ketone bodies are excreted through the urine.

Eclampsia : Eclampsia is a convulsive form of gestational hypertension and is known to be associated with ketonuria.

Vomiting and Diarrhea : Vomiting and diarrhea causes the body to go into starvation mode, and it involves breaking down fat for fuel to produce energy. This leads to the production of excess ketones in the body, which then accumulate in the blood. Excess ketones are excreted through urine.

Glycogen Storage Disease : This is a group of inherited disorders in which normal glycogen production is reduced, while abnormal glycogen accumulates in tissues.

Therefore, the body lacks an adequate amount of carbohydrate fuel for energy, forcing it to rely on fatty tissues to meet the demand. This leads to the accumulation of ketone bodies.

Intense and strenuous exercise : Exercising your muscles increases the demand for energy. In the absence or depletion of glucose storage, the body seeks alternative sources of fat.

The use of these alternative fuels leads to the production of ketone by-products. The accumulated ketones are released through the urine.

Other possible causes of ketonuria include prolonged exposure to cold temperatures and fever.

You should not wait for an emergency situation to occur before knowing when to identify your urine ketone level. Check with your doctor first, as they will guide you to diagnosis and treatment.

Here are some examples of when one should enter to check the level of ketones in urine:

  • When one has certain ailments, that is, suffering from the flu, cold, sore throat, cases of food poisoning or any other medical condition.
  • When you have unexplained high blood glucose levels above 250 mg / dl twice in a row.
  • When you are planning to exercise but have blood glucose levels above 250 mg / dl.
  • A pregnant woman should always check ketones regularly every morning before eating breakfast.
  • If a person is diagnosed with symptoms related to diabetic ketoacidosis. These symptoms include increased urination, pain in the abdomen, and dry mouth.
  • If one’s insulin pump is malfunctioning, causing an interruption in insulin delivery.
  • Whether an individual is experiencing or has experienced traumatic stress cases .
  • Certain lifestyle changes that have caused excessive stress.

Once the doctor determines the presence of ketones, the first general treatment would include increasing the consumption of fluids such as water or any other liquid without calories to remove excess ketones from the body.

Insulin should also be taken regularly to lower and monitor blood glucose levels, as well as ketone levels in the body every two to three hours each day.

If ketones are present, the doctor may also recommend additional insulin to lower blood glucose levels. If ketone levels are still not decreasing, the patient will need to be admitted to the hospital.

Diagnosis and treatment

A blood test is an accurate diagnostic test for ketonuria. But, in most cases, urine ketone testing is the recommended screening method. A urine test is based on spot tests on a dipstick.

Dip sticks contain chemicals that indicate the presence of ketones in the form of a color change. The dipstick is placed in a urine sample to check for color change. The change is compared to a color chart.

In preparation for the test, the doctor may ask the patient to avoid some supplements and medications that will interfere with the test result. These include glucocorticoids, levodopa, metformin , methionine, captopril, and vitamin C.

The normal range for ketones is less than 0.6 mmol / L and may show as a negative result. A ketone range of 0.6 to 1.5 mmol / L can indicate the presence of small amounts of ketones in the blood.

High ketone levels are indicated by a range of 1.6 to 3.0 mmol / L. Dangerous level is expressed as a ketone value greater than 3.0 mmol / L. It is important to monitor blood ketone levels and report to the doctor accordingly.

High or increasing ketone values ​​can be found through poorly controlled diabetes, starvation, diet, poisoning, alkalosis, and some metabolic disorders.

Since ketonuria is associated with uncontrolled diabetes, taking extra insulin to lower blood glucose can help control ketone levels in the blood. Treatment of ketonuria depends on the underlying cause of the disease.

A healthy, balanced diet will help control the condition caused by diet and starvation. Closely monitoring blood ketone levels, particularly in diabetic patients, can help prevent the occurrence of ketonuria.

Avoiding prolonged exposure to strenuous and severe exercise also helps prevent ketonuria, particularly in those who are at high risk of developing this condition.

Lifestyle changes are equally important in the management of ketonuria. Avoiding a ketogenic diet, a diet high in fat and low in carbohydrates, is an ideal step to control the production of ketones in the body.

A ketogenic diet mimics starvation, so the body tries to find alternative processes for energy production. Fresh fruits and vegetables should be included in the diet. Eating low glycemic index (GI) foods can help control the condition.

Some common low GI foods include cucumber, kale, eggplant, peaches, cauliflower, bell peppers, and okra. You should not exercise or diet if ketone levels are high.

Treatment with insulin and intravenous fluids is used to restore blood sugar levels to normal levels. This helps reduce ketones.

Other treatments may include:

Intravenous (IV) Fluid Replacement : One of the symptoms of ketonuria is frequent urination, which ultimately results in the loss of fluids from the body.

Therefore, keeping the body hydrated is essential. Your doctor may suggest rehydration with IV fluids to help dilute the extra glucose in your blood.

Insulin : In some emergency situations, people receive insulin through the IV method. This is done to improve the body’s ability to use excess glucose in the blood for energy production.

In such cases, glucose levels are tested hourly. VI insulin is no longer needed when ketones and acid levels in the blood return to normal, after which the normal insulin regimen can be resumed.

Electrolyte replacement: Sometimes electrolyte levels can be very low. Some examples of electrolytes include sodium, chloride, and potassium. If the loss of these electrolytes is too great, the heart and muscles cannot function properly.

Complications of ketone bodies

Studies reveal that ketones can cause heartburn in the blood, which is known to cause diabetic ketoacidosis. This in turn causes several side effects that can be life threatening, such as:

  • Diabetic coma.
  • Swelling in the brain
  • Loss of consciousness.
  • Death.

Therefore, it is very important to plan immediate treatment when ketone levels rise above the normal range.


Careful diabetes management is one of the keys to preventing ketone bodies from rising. The following steps will ensure that your blood sugar is kept at a healthy level and ketone production is minimized.

Check Blood Sugar Levels Regularly – Your doctor will give you suggestions on how often to check your blood sugar levels. Usually this is done four to six times a day. However, one should check blood sugar levels more frequently in cases like:

  • When one is sick.
  • If there are any symptoms of high or low blood sugar.
  • If blood sugar levels grow higher than the normal range.

Diet changes: keep track of what you eat on a daily basis. Controlling your carbohydrate intake and insulin dose is very important for treating diabetes. Talk to a dietitian for a better diet.

It is also recommended that pregnant women and nursing mothers eat a well-balanced diet with adequate amounts of fat, protein, and carbohydrates. Inadequate carbohydrates can cause ketones in the urine. Include fresh fruits, vegetables, dairy products, and cereals in balanced proportions.

Cinnamon is popularly known to enhance the absorption of sugar in the cells of the body, even when there is no insulin.

One should consume at least two to three grams of cinnamon after meals. This is very beneficial among patients suffering from diabetes. However, a faulty diet can also cause hypoglycemic attacks.