On what they are, what their normal values should be and how to treat elevated urinary ketones.
Table of contents:
- What are urine ketones?
- What do urine ketones in pregnancy mean?
- Urine ketones - norm
- Ketones in urine - causes
- Ketones in urine - how to get rid of them?
- Urine ketones 50 mg/dl
- Urine ketones 15 mg/dl in pregnancy
- Urine ketones in pregnancy with diabetes mellitus
What are urine ketones?
Ketones, or ketone bodies, are chemical compounds that are intermediate products of fat metabolism. The process of formation of ketone bodies takes place in the liver and is called ketogenesis. The ketones formed in the liver are not processed by the liver, but pass into the bloodstream, where they can sometimes be used as an energy material to replace glucose. These include B-hydroxybutyric acid, acetylacetic acid and acetone. Under physiological conditions, they are found in the blood in trace amounts in healthy individuals. If, however, there is an increased production of ketone bodies in the body (for various reasons), elevated values can be detected in the urine. Such a condition is called ketonuria. It should be remembered that in healthy people, these should not occur at all.
What do urinary ketones in pregnancy mean?
Ketone bodies in the urine during pregnancy, under physiological conditions, should not occur. In pregnant women, ketonuria is often a consequence of intense vomiting occurring most frequently in the first trimester of pregnancy. Slightly less frequently, it can be caused by excessive exercise. Increased urinary ketones in pregnant women should also be a signal for carbohydrate control, as they are often a sign of type I diabetes. The value of ketones in the urine during pregnancy can be determined by a common and simple general urine test. Special strip tests are available from the pharmacy to detect abnormalities also at home.
Urine ketones - normal
Ketone bodies in a healthy person are produced in very small, trace amounts. In healthy individuals, the serum level of ketone bodies does not exceed 0.2 mmol/l (in blood). In the urine of healthy people, ketone bodies should not be present at all.
Ketones in urine, photo: panthermedia
The level of ketone bodies is divided into 3 categories, for which the values are respectively:
(a) <20 mg/dl - low,
(b) 20 - 40 mg/dl - medium,
(c) >40 mg/dl - high.
Ketones in urine - causes
Ketones in the urine indicate that the body has started to take up energy from fats. There can be many reasons for this, although the most common is unbalanced glycaemia - poorly controlled or undiagnosed diabetes. Such abnormal carbohydrate metabolism, caused, for example, by insulin deficiency, forces the body to draw energy from other substrates, including fats. In addition, the presence of ketones in the urine can be caused by:
- a disorder of the pancreas (inflammation, tumours),
- frequent consumption of alcohol in large quantities,
- eating disorders such as bulimia, intermittent starvation or high-protein or high-fat diets,
- exhaustive, excessive physical exertion,
- thyroid disease,
- frequent diarrhoea and vomiting,
- pregnancy,
- taking certain medications,
- metabolic diseases.
Ketones in urine - how to get rid of them?
If you detect elevated levels of ketone bodies in your urine, you should always be guided to normalise their values. It is important to remember that the basis of good treatment is the correct determination of the concentration of ketone bodies and the reason for their excessive production. In order to do this, it is necessary to prepare properly for the test. This means that a few rules should be observed before the urine test:
- remain fasting for 8 h,
- the day before the test do not consume products that may change the colour of the urine,
- consult a general practitioner to rule out medications that may adulterate the result,
- for women, do not urinate for the test during menstruation,
- wash hands and urethral area thoroughly, and collect urine from the central stream.
Once the level of ketone bodies has been determined and additional tests performed, treatment is always carried out, treating the cause causing the ketonuria. Depending on the aetiology of the abnormal ketone values, treatment may consist of: regulating glycaemic values, treating pancreatic and thyroid disease, stopping alcohol, eating regular meals or composing a complete diet.
Urinary ketones 50 mg/dl
According to the categorisation according to the concentration of ketones in urine, a result of 50 mg/dl indicates a high level. Unfortunately, such concentrations may suggest serious disorders of the body, such as thyroid or kidney disease with a severe, sometimes violent course. High levels usually indicate uncompensated or undiagnosed diabetes in the first instance.
Urine ketones 15 mg/dl in pregnancy
Urinary ketones in pregnancy are best detected in morning urine, always from the midstream. The classification of the severity of ketonuria depends on their concentration in the urine. A concentration of less than 20 mg/dl is defined as a low level of ketones. Thus, a result of 15 mg/dl would indicate a low level. However, it should be remembered that even such a result should prompt a pregnant woman to see a specialist. Absolutely if it is accompanied by symptoms such as fatigue, excessive thirst, abdominal pain, nausea or acetone odour from the mouth.
Urine ketones in pregnancy with diabetes mellitus
As mentioned above, elevated levels of ketone bodies in pregnant women can be caused by diabetes. A condition in which glycaemic values are not normalised in these patients can sometimes be a life and health-threatening situation for both mother and child. Therefore, it is important to be observant and to react immediately if worrying symptoms such as abdominal pain, nausea, vomiting, frequent large amounts of urine, constant thirst, headaches, dry mouth and breath with a characteristic acetone smell appear. Unfortunately, these symptoms are not very specific and, therefore, the mother-to-be may treat them as standard pregnancy symptoms. This is why it is so important to have blood and urine tests at least once a month. These symptoms should not be underestimated, as high concentrations of ketone bodies can have a neurotoxic effect (damage to the baby's nervous system).
