Ketones in Urine: When and Why to Test for Them and What They Mean

Introduction

Urine formation is a complex process that involves the filtration of blood in the kidneys followed by the reabsorption of useful substances, and finally the excretion of waste products. One of the waste products that can be found in urine is ketones, which are produced when the body burns fat for energy. While small amounts of ketones in urine are normal, high levels can be a sign of a medical condition. Ketone testing in urine can therefore provide valuable insights into a person’s health and well-being. Let us know more about this in the further sections.

Reasons for Testing Ketones in Urine ^1,2

The ketone urine test will help people who have a high level of ketones in their urine, a condition called Ketoacidosis. 

The risk factors for this condition include the following: 

• Uncontrolled diabetes
• Alcohol abuse 
• Vomiting
• Diarrhoea 
• Starvation
• Eating disorders
• Pregnancy 

Your doctor may recommend you this test if you have the following symptoms:

• Abdominal pain
• Trouble breathing 
• Confusion
• Feeling sleepy or tired

Timing of Ketone Testing

Urbain et al. conducted a study in 2016 to find out the best suitable time of the day to test for urinary ketones. The results of this study showed that ketones can be reliably detected in the urine early morning and after dinner.³ if you plan to do a ketone urine test at home, it is best to consult your doctor about reliable kits and the most suitable timing for the test.

Methods of Ketone Testing²

If your healthcare professional recommends you ketone testing, you would have to provide your urine sample to the laboratory for testing. Your healthcare professional will provide you with cleansing wipes, a container for sample collection and will instruct you about the method for “clean catch” urine sample.

The following steps should be kept in mind while urine sample collection:

• Wash your hands thoroughly with soap and water and dry them using a towel.
• Next, open the container without touching the inside part of the container.
• With cleansing wipes, you should clean your genital area properly.
• For a few seconds urinate into the toilet and then stop the flow for a few seconds, during this interval place the container and start urinating into the container to collect the sample.
• The sample should be collected as per the markings on the container or as instructed.
• Once done, close the container and return it in a polythene bag or as instructed.

Note: if you have menstrual periods or are having piles/haemorrhoids that bleed, inform your healthcare professional before giving a sample. 

Ketone urine test is also known as ketone test, ketone body test or urine ketone test.

Ketone kits are available without a prescription at local pharmacy stores. If you plan to do a ketone test yourself at home, they are usable as it is. However, it is best to always consult the doctors for the most reliable information related to your condition. 

Did you know, ketones are produced by the liver? If there has been a long gap since your last meal, your liver starts breaking down fats converting them into ketones. An excess of this ketone buildup is called ketoacidosis.

Dr. Siddharth Gupta, B.A.M.S, M.D (Ayu)

Interpreting Ketone Test Results

The normal range for ketones in urine may vary for different laboratories. However, the general recommendations for the test results as given below:

• Normal: Trace
• Mild: 1+
• Moderate: 2+
• Severe: 3+

Test results may range from 0(not detected) to +4(high). The normal range is below 0.6 mmol/L.^4,5

Significance of Ketone Testing

• Ketone testing becomes important, especially for poorly controlled diabetes which is the most common cause of ketones in the urine. A study conducted by Praveen et al. conducted a review in 2021 which stated that nearly one-third of the Indian youth with Type I diabetes presents with increased level of ketones.⁷ 
• Urine ketone test helps decide the dosage of insulin for patients with uncontrolled diabetes. In uncontrolled diabetes, the body starts using ketones as a source of energy instead of glucose. This results in a high level of blood glucose in the body and thus, necessitates insulin dose adjustment.
• The absence or presence of ketones in urine also helps in classifying fasting hypoglycemia (low blood glucose levels) in childhood and infancy. During fasting, your body uses ketones as a fuel or energy source. Thus, reduced ketone levels also compromise the ability of the body to conserve glucose and can cause hypoglycemia. A urine ketone test will help identify and classify fasting hypoglycemia.
• The presence of ketones in urine also reveals excessive alcohol consumption. Alcohol causes inhibition of the body’s ability to produce glucose and thus, causes an increase in ketone levels to meet the energy requirements.

Note: The widespread use of self-blood glucose monitoring has reduced the importance of testing ketones in urine, and can often result in untreated ketoacidosis.

Ketoacidosis can be considered the first sign of type 1 diabetes in people who have not yet been diagnosed. However, those that suspect ketoacidosis should consult a doctor and discuss their symptoms before self-medicating as diabetes is a serious condition.

Dr. Rajeev Singh, BAMS

Conclusion

Testing ketones in the urine is important in cases of poorly controlled diabetes, insulin dosage adjustments, and to identify excessive alcohol consumption. The ketone urine test will help monitor people who have a high level of ketones in their urine, a condition called ketoacidosis. The test requires screening the urine samples in laboratories for the presence of ketones; these days urine ketone testing can be conveniently carried out at home too. It is important for individuals especially those with diabetes to be aware of their urinary ketone levels and to work with their healthcare providers to maintain a healthy lifestyle and prevent progression or deterioration of their health conditions. 

Frequently Asked Questions (FAQs):

References

1. Ghimire P, Dhamoon AS. Ketoacidosis. InStatPearls [Internet] 2022 Aug 8. StatPearls Publishing. Available at: https://www.ncbi.nlm.nih.gov/books/NBK534848/
2. Ketones in urine. Medline Plus.  National Library of Medicine; 2023. Available at: https://medlineplus.gov/lab-tests/ketones-in-urine/
3. Urbain P, Bertz H. Monitoring for compliance with a ketogenic diet: what is the best time of day to test for urinary ketosis? Nutrition & metabolism. 2016 Dec; 13(1):1-6. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5097355/
4. Dhillon KK, Gupta S. Biochemistry, ketogenesis. InStatPearls [Internet] 2022 Feb 10. StatPearls Publishing. Available at: https://www.ncbi.nlm.nih.gov/books/NBK493179/
5. Baris KU, Sever M, Aksay E, Dogan T, Yalcin N, Eren ES, Ustuner F. Comparing finger-stick β-hydroxybutyrate with dipstick urine tests in the detection of ketone bodies. Turkish Journal of Emergency Medicine. 2014 Jun 1; 14(2):47-52. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4909883/
6. Comstock JP, Garber AJ. Ketonuria. InStatPearls [Internet] 1990. Available at: https://www.ncbi.nlm.nih.gov/books/NBK247/
7. Praveen PA, Hockett CW, Ong TC, Amutha A, Isom SP, Jensen ET, Mohan V, Dabelea DA, D’Agostino Jr RB, Hamman RF, Mayer‐Davis EJ. Diabetic ketoacidosis at diagnosis among youth with type 1 and type 2 diabetes: results from SEARCH (United States) and YDR (India) registries. Pediatric diabetes. 2021 Feb; 22(1):40-6. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7748377/

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