Ketones, Urine

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What are ketones?

Ketones are produced when the body burns fat for energy. Normally, your body gets the energy it needs from carbohydrates in your diet. But stored fat is broken down and ketones are made if your diet does not contain enough carbohydrate to supply the body with sugar (glucose) for energy or if your body can't use blood sugar (glucose) properly.

Having some ketones in your urine is normal. However, high ketone levels in urine may be a sign of too much acid in your body (ketoacidosis). The most common and life-threatening type of ketoacidosis is a complication of diabetes called diabetic ketoacidosis (DKA). If left untreated DKA can cause damage to organs and even death. This is why it is important to know the signs of ketonuria and when to check your ketone levels with a urine or blood test.

Where are ketones formed?

Ketones are usually formed in the liver and are broken down so that normally very small amounts of ketones appear in the urine. 

When are ketones produced?

Ketones are produced when the body burns fat for fuel. Normally these ketones will be completely broken down (metabolised) so that there are very few ketones in the urine. If for any reason the body cannot get enough glucose for energy it will switch to using body fats, causing an increase in ketones in the body. This results in more ketones in urine.

When does fat become the main source of energy for your body?

When carbohydrates are unavailable (for example, in starvation) or when they cannot be used as an energy source (for example, in diabetes), fat becomes the main source of energy and large amounts of ketones are made. Therefore, higher levels of urine ketones indicate that the body is using fat as the major source of energy.

Is there a link between ketones and diabetes?

Severe insulin deficiency causes an increase in blood sugar (glucose) levels (hyperglycaemia) and a very high level of ketones in the blood and urine (ketoacidosis).


American Diabetes Association; c1995-2022. Diabetes & DKA (Ketoacidosis); https://www.diabetes.org/diabetes/dka-ketoacidosis-ketones

Hinkle J, Cheever K. Brunner & Suddarth's Handbook of Laboratory and Diagnostic Tests. 2nd Ed. Philadelphia: Wolters Kluwer Health, Lippincott Williams & Wilkins; c2014. Ketones: Urine; p. 351.

Ghimire P, Dhamoon A. Ketoacidosis. StatPearls Publishing https://www.ncbi.nlm.nih.gov/books/NBK534848/

Joslin Diabetes Center [Internet]. Boston: Joslin Diabetes Center, Harvard Medical School; c2022. Ketone Testing; https://www.joslin.org/patient-care/diabetes-education/diabetes-learning-center/ketone-testing-0

Masood W, Annamaraju P, Uppaluri KR. Ketogenic Diet. StatPearls Publishing https://www.ncbi.nlm.nih.gov/books/NBK499830/

National Institute of Diabetes and Digestive and Kidney Diseases  https://www.niddk.nih.gov/health-information/diabetes/overview/managing-diabetes

Paoli A. Ketogenic Diet for Obesity: Friend or Foe? Int J Environ Res Public Health  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3945587

Saint Francis Health System [Internet]. Tulsa (OK): Saint Francis Health System; c2010. Patient Information: Collecting a Clean Catch Urine Sample; https://www.saintfrancis.com/assets/documents/lab/collecting-a-clean-catch-urine.pdf

Testing.com https://www.testing.com/tests/urinalysis/#ketones

The Johns Hopkins Lupus Center https://www.hopkinslupus.org/lupus-tests/screening-laboratory-tests/urinalysis/

UF Health: University of Florida Health - Ketones urine test: Overview; https://ufhealth.org/ketones-urine-test

University of Rochester Medical Center https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=167&contentid=ketone_bodies_urine

Luethi N, Cioccari L, Crisman M, Bellomo R, Eastwood GM, Mårtensson J. Prevalence of ketosis, ketonuria, and ketoacidosis during liberal glycemic control in critically ill patients with diabetes: an observational study. Crit Care. 2016;20:297. doi:10.1186/s13054-016-1462-7

What does it mean if your Ketones, Urine result is too high?

When you have high ketone levels in your urine we call this Ketonuria. This condition is also called ketoaciduria and acetonuria.

Ketones or ketone bodies are types of acids. Your body makes ketones when fats and proteins are burned for energy. This is a normal process. However, it can go into overdrive due to some health conditions and other reasons.

Ketonuria is most 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 rise too high for too long, your blood becomes acidic. This can harm your health.

So, if you have ketones in your urine, it is an indication of an insulin problem.

The causes of high levels of ketones and therefore urine ketones include:

  • Poorly controlled diabetes.
  • Diabetic ketoacidosis (DKA).
  • Starvation: not eating for prolonged periods (for example, 12 to 18 hours).
  • Anorexia nervosa.
  • Bulimia nervosa.
  • Alcohol dependency.
  • Ketogenic diet (high-fat, low-carbohydrate diet). This can cause an increase in body ketones but much less than DKA and not usually harmful to the body. Ketogenic diets have been used as a treatment for epilepsy.

Symptoms of a high ketone levels:

High levels of ketones in your body can cause tummy (abdominal) pain, feeling sick (nausea), being sick (vomiting) and diarrhea. The ketones that most often appear in the urine when fats are burned for energy are called acetoacetate and beta-hydroxybutyric acid.

What is diabetic ketoacidosis?

If you have uncontrolled diabetes, ketone levels can skyrocket. High levels can cause acids to rapidly accumulate in the blood, leading to ketoacidosis. This is damaging to your vital organs and can even lead to death if not treated appropriately.

In people with diabetes, the condition is known as diabetic ketoacidosis (DKA). In those without, it is referred to as non-diabetic ketoacidosis (non-DKA).

DKA is a serious problem that can occur in people with diabetes if their body starts to run out of insulin. This causes ketones to build up in the body, which can be life-threatening if not spotted and treated quickly. DKA mainly affects people with type 1 diabetes but can sometimes occur in people with type 2 diabetes.

If you have diabetes, it's important to be aware of the risk and know what to do if DKA occurs. 

Symptoms of DKA include:

  • Needing to pass more urine than usual.
  • Feeling very thirsty.
  • Feeling sick (nausea) and being sick (vomiting).
  • Tummy (abdominal) pain.
  • Your breath smells fruity (like pear drop sweets).
  • Your breathing becomes fast and deep.
  • Feeling very tired and confused and as though you may collapse.

Complications of ketoacidosis include:

Acute kidney failure: 

This is a serious but generally reversible condition in which the kidneys stop filtering blood.

Pulmonary edema: 

This is where fluid builds up in the lungs, causing severe breathing problems.

Cerebral edema: 

This is a medical emergency where the brain swells and doesn't get enough oxygen, leading to seizures, loss of consciousness, and other symptoms.

Cardiac arrest: 

This is a life-threatening situation in which the heart stops beating.

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