Ketonuria: Causes, Symptoms, Diagnosis, Treatment, Complications and Outlook

It occurs when you have high levels of ketones in your urine. This condition is also called ketoaciduria and acetonuria.

Ketones or ketone bodies are acids; your body produces ketones when fats and proteins are burned for energy; this is a normal process.

However, it can go into overdrive due to health conditions. Ketonuria is more common in individuals who have diabetes, particularly type 1 diabetes mellitus.

It can also occur in women who are pregnant or breastfeeding. If ketone levels skyrocket for too long, your blood becomes acidic, harming your health.

What are the causes of ketonuria?

Cetogénica diet

Ketonuria signifies that your body primarily uses fat and protein for fuel. This is called ketosis, a standard process if you are fasting or on a low-carb ketogenic diet, which usually doesn’t pose a health risk if done in a balanced way.

Low insulin levels

Most of the energy your body uses comes from sugar or glucose. This is usually from the carbohydrates you eat or from stored sugars. Insulin is a vital hormone that carries sugar to all cells, including muscles, the heart, and the brain.

People with diabetes may not have enough insulin or be able to use it properly. Without insulin, your body cannot efficiently move sugar into your cells or store it for fuel, so you must find another power source.


The body’s fats and proteins are broken down for energy, producing ketones as a waste product. When too many ketones build up in the bloodstream, ketoacidosis or diabetic ketoacidosis can occur.

This is a life-threatening condition that makes your blood acidic and can damage your organs. Ketonuria usually occurs in conjunction with ketoacidosis; as ketone levels rise in the blood, the kidneys try to eliminate them through the urine.

If you have diabetes and have developed ketonuria, you likely also have high blood sugar or hyperglycemia. Without enough insulin, your body cannot properly absorb sugar from digested food.

Other causes

You can develop ketonuria even if you don’t have diabetes or are on a strict ketogenic diet.

These different causes include:

  • Drinking alcohol excessively.
  • Severe vomiting
  • The pregnancy.
  • Starvation.
  • Illness or infection
  • Heart attack.
  • Emotional or physical trauma.
  • Medications, such as corticosteroids and diuretics.
  • Drug use

What are the symptoms?

Ketonuria can signify that you have ketoacidosis or leading to it. The higher the ketone levels, the more severe the symptoms and the more dangerous it becomes. Depending on the severity, signs and symptoms may include:

  • However.
  • Fruity-smelling breath.
  • Dry mouth.
  • Fatigue.
  • Nausea or vomiting
  • Frequent urination
  • Confusion or difficulty focusing.

Your doctor may find other signs related to ketonuria:

  • Sugar in the blood.
  • High dehydration.
  • Significant electrolyte imbalance.

Also, there may be signs of illnesses like sepsis, pneumonia, and urinary tract infections that can lead to high ketone levels.

How is ketonuria diagnosed?

Ketonuria is commonly diagnosed through a urine test. Your doctor will also review your symptoms and medical history. Standard tests for ketones in your urine and blood include:

  • Finger-stick ketone blood test.
  • Urine strip test.
  • Acetone breath test.

You may also have other tests and scans to look for the cause:

  • Blood electrolytes.
  • Complete blood count.
  • Chest x-ray
  • CT scan.
  • Electrocardiogram
  • Blood culture to detect infections.
  • Blood glucose test.
  • Anti-doping control.

On the other hand, the American Diabetes Association recommends monitoring your ketone levels if you have diabetes, mainly when your blood sugar level is more than 240 milligrams per deciliter.

You can test for ketones with a simple urine test strip. Some blood glucose monitors also measure ketones in the blood. This involves pricking your finger and putting a drop of blood on a test strip.

Home tests may not be as accurate as a urine or blood test at your doctor’s office, but you can purchase ketone test strips and machines that you can use at home.

Test ranges

Regular ketone tests are critical if you have diabetes. Your urine test strip will change color; each color corresponds to a range of ketone levels displayed on a graph.

When ketones are higher than usual, you need to check your blood glucose level. Take immediate action if necessary.

Distance Results

Less than 0.6 millimoles per liter Normal level of ketones in the urine

0.6 to 1.5 millimoles per liter Higher than usual, test again in 2-4 hours

1.6 to 3.0 millimoles per liter Moderate ketone level in urine; call your doctor immediately

Above 3.0 millimoles per liter, Dangerously high level; go to the emergency room right away

How is it treated?

If your condition is due to a temporary fast or changes in your diet, it is likely to resolve on its own; in that case, you will not need treatment, but if you are in doubt, you can test your ketone levels as well as your blood sugar level and go to your doctor for follow-up appointments to make sure.

In more challenging situations, treatment with ketonuria is similar to treatment for diabetic ketoacidosis. You may require life-saving therapy with:

  • Fast-acting insulin.
  • Fluids IV.
  • Electrolytes such as sodium, potassium, and chloride.

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

  • Antibiotics
  • Antivirals.
  • Heart procedures.

Ketonuria complications

In more severe cases, ketonuria is capable of causing significant complications that affect your health. It can even lead to a coma or death.


Diabetic ketoacidosis is a health emergency that can lead to a diabetic coma and even death. Increased ketones in the blood increase acid levels; thus, elevated acid states are toxic to organs, muscles, and nerves and interfere with bodily functions.

This disease can occur to anyone with diabetes, but it is most expected in people with type 1 diabetes.


High blood sugar levels lead to increased ketone levels, significantly increase urination, and can lead to dehydration. Diseases that cause ketonuria can also cause nausea, vomiting, and diarrhea, increasing dehydration.

In pregnancy

Ketonuria is common even in a healthy pregnancy. It can happen if you do not eat for an extended period when you are on a low-carb diet or experience excessive vomiting. Pregnant women with diabetes or gestational diabetes are at increased risk for the condition.

This can lead to ketoacidosis, which can harm the baby during development. If you have gestational diabetes, your doctor may recommend treatment through diet and medications such as insulin. Treatment usually resolves ketonuria.

You will need to regularly monitor your blood sugar levels and ketone levels during pregnancy. After your baby is born, your doctor or nutritionist will recommend changes to your diet. Correct food choices are an essential step in managing and treating gestational diabetes.

What’s the outlook for ketonuria?

This condition can be caused by many factors, including what you eat. It may also be due to an imbalance in your diet or have a more severe cause. You should see your doctor immediately if you think you have ketonuria, as the most important key to treatment is identifying the cause.

In many cases, you can avoid it. For example, prevent extreme diets and talk to your doctor or nutritionist before making drastic changes to your daily diet.

Ketonuria can be a warning sign that something is wrong. If your symptoms include confusion, headache, nausea, or vomiting, seek emergency medical attention.

If you have diabetes, ketonuria is usually a warning sign that your diabetes is not under control. Check your ketone levels as often as you check your blood glucose levels.

Record your results to show your doctor. Talk to your doctor about what you can do to balance your blood sugar levels.

Your doctor may prescribe insulin or various other medications, and you may need the help of a dietitian to help you choose your foods. Diabetes educators can also help you manage and understand your condition.