ketone bodies in urine

Introduction

also see ketone bodies in serum/plasma/urine

Indications

• assessment of diabetic ketoacidosis
• verification of compliance with weight-reducing regimen

Reference interval

• urine: negative, limit of detection 5-10 mg/dL (0.5-1.0 mmol/L)

Increases

• chemical interferences
  • urine (in vitro)
    • acetylcysteine, captopril, cysteine, dimercaprol (BAL), 8-hydroxyquinoline (preservative), levodopa, MESNA (2-mercaptoethane sulfonate), D-penicillamine, phenazo- pyridine, phenolphthalein, phenylketones
  • urine (in vivo)
    • aspirin intoxication, ethanol, ether anesthesia, inositol, isopropanol, metformin, methionine, nicotinic acid, phenformin, valproic acid
  • hemolysis causes discoloration of test tablets or sticks
• clinical disorders
  • diabetic ketoacidosis*, prolonged fasting, severe carbohydrate restriction with normal fat intake (weight- reducing diets), anorexia nervosa, persistent vomiting, glycogen storage diseases, branched chain ketonuria, methylmalonic aciduria, exercise in untrained subjects, pregnancy, stress, post-anesthesia
  • states with markedly increased metabolic rates
    • high fever, severe thyrotoxicosis, active acromegaly
  • excessive hormone production/administration
    • growth hormone, ACTH, glucocorticoids, hyperinsulinism, catecholamines

* In some cases of diabetes mellitus with elevated blood ketone levels, no ketone bodies appear in the urine.

Methods

• reagent strip: nitroprusside (Miles Inc. Acetotest, Ketostix, Labstix, Multistix, BMC Chemstrip)
• beta-hydroxybutyrate is NOT measured
• acetone is measured by Chemstrip & Acetest
• False positives (urine):
  • highly pigmented urine
  • specimens with 8-hydroxquinoline as a preservative

Specimen

• urine

More general terms

• ketone bodies in body fluid
• urine chemistry test

Additional terms

• beta(3)-hydroxybutyrate in blood/plasma/serum