Factors that affect the appearance of ketone bodies (ketones) in the urine of a child.

Acetonuria (ketonuria) is a pathological condition characterized by the appearance of acetone in the urine. Ketones (Ketone bodies, acetone) are by-product metabolites of protein and fat-containing substances.

Normally, the body receives energy from glucose, that is, from carbohydrate products. Under pathological conditions, protein and lipid compounds are included in the metabolism, which leads to increased formation of metabolic by-products - ketone bodies.

When ketones are detected in urine, their presence in the blood is inevitable. Acetonemia is a condition characterized by an increase in the level of acetone in the blood. Small trace amounts of ketones in the blood are normal. Their secretion is ensured by many body systems. Ketones are excreted along with:

• urine (urine),
• exhaled air,
• Then,

The detection of acetone in urine is a serious abnormality, which requires further diagnosis and therapy.

Acetonuria is often detected in children and pregnant women. Today, it is already difficult to surprise a doctor with acetone in the urine of an adult.

The most common reason for the appearance of acetone in the urine is a diet violation, such as excessive consumption of protein and fatty foods. Ketonuria is often a consequence of a violation of the water regime, during hot weather, exhausting diets or heavy physical activity. Diabetes deserves a separate discussion. In diabetes mellitus, the mechanism for the appearance of ketone bodies is somewhat different.

What are ketones in urine?

The final interpretation of the analysis, as well as the ability to study the results, will directly depend on the method of its implementation. Only a medical professional can make a detailed diagnosis.

Home test samples give an approximate result; after lowering the strip into the urine, the indicator zone receives a color, which indicates the result, but you still need to take a urine test in the laboratory again. When tested, concentrations from zero to 15 mmol/l are detected, but exact data in this case are not available.

When a purple tint appears, the situation becomes critical. When tested with ammonia, the color of the urine may turn red, in which case there are definitely ketones in the body. In a general urine test, many elements can be seen, including protein, nitrites, leukocytes, and red blood cells. But only an experienced doctor can say what these indicators mean if traces of ketone bodies are additionally detected in the analysis.

Laboratory testing makes it possible to diagnose elevated or normal ketone levels. To detect diabetic ketoacidosis, a specialized blood test is used to detect large amounts of ketones rather than a general one. In this case, you need to test with an acid called beto-hydroxybutyric acid. The determined value will be the unit of measurement mmol/l. If the acid content ranges from zero to 0.5 mmol/l, this is normal, but if a value of 0.5 mmol/l is shown, then this is an increased norm. This condition is already borderline, and indicates the likelihood of developing the disease. Therefore, when beto-hydroxybutyric acid is detected at a concentration of 0.5 mmol/l, the test must be repeated in order to increase the chances of a correct diagnosis. If the indicators of the next analysis are lower, then this is a normal result.

Negative effects of ketone bodies on the child’s body

The development of ketoacidosis is always associated with many factors that have a negative impact on the child’s body, causing vomiting, dehydration and pain.

What does acetone mean in a child's urine?

1. If ketones are elevated, the body becomes acidic and ketoacidosis develops. When trying to compensate for the lost alkaline reserve, the body begins to get rid of carbon dioxide through intense hyperventilation of the lungs, which causes cerebral vascular spasm.
2. A large number of ketone bodies reduces the conductivity of the central nervous system, sometimes with subsequent development of coma.
3. The lack of oxygen, which is used in large quantities to get rid of ketones, contributes to further deterioration of the condition.
4. An increased concentration of ketone bodies has an irritating effect on the mucous membrane of the stomach and intestines, which provokes vomiting and abdominal pain.
5. Acetone has a destructive effect on cell membranes.

The complex of negative effects is complemented by dehydration and impaired lactic acid metabolism, which significantly complicates the course of the disease and complicates treatment.

The normal level of ketones in a child’s urine is no more than 50 mg/l

To compensate for dehydration, it is recommended to drink the drug Regidron

Keacidosis is caused by many factors, leading to various unpleasant symptoms. Parents should be aware of this condition in advance in order to take appropriate measures to normalize this process, as well as prevent negative consequences.

Everyone should be aware of the effects of ketone bodies, including what it means for the body and how it is expressed.

Consequences for the child:

1. If the level of detected ketones is elevated, ketoacidosis occurs. Any attempts to replenish the lost alkaline reserve lead to ridding the body of carbon dioxide. This occurs due to the intense work of the lungs, which can cause spasms affecting the blood vessels of the brain.
2. Excessive amounts of ketones reduce the conductivity of nerve endings, and in some cases leads to the development of coma.
3. Vision deteriorates due to a lack of oxygen, which is actively used to get rid of ketone bodies.
4. The mucous membranes of the intestines and stomach are irritated, resulting in attacks of vomiting and pain in the abdominal area.
5. Cell membranes are destroyed.

The listed negative changes occur in situations in which there is an excess number of ketones compared to their level in a healthy person (the norm is no more than 50 mg/l).

How are ketones formed in urine?

Ketone bodies are by-products of metabolism:

• acetone;
• acetoacetic acid;
• beta-hydroxybutyric acid.

Ketone bodies increase after prolonged fasting, low-carbohydrate diets, as a result of metabolic problems, such as diabetes. Ketones are a reserve source of energy that is used when there is insufficient sugar intake or if it is not absorbed. Formed in the liver as a result of the breakdown of fats. Yes, the same ones that are deposited on the surface of internal organs, as well as in various areas under the skin. As a rule, a surge of ketones in the blood is observed on the 6th day from the start of fasting. The release of ketones is also possible after intense training, for example during the drying period in athletes, or severe stress, for example before exams. As we can see, the formation of ketones is a normal process. In a healthy person, they are constantly produced in small quantities and are gradually neutralized by the liver, after which they are excreted in the urine.

When fat metabolism is exceeded, hormonal imbalances occur, ketones are released in an abnormally large volume. The liver does not have time to process the entire volume. Periodic surges are observed during diabetes mellitus - they signal energy starvation, and, accordingly, improper treatment of the disease.

In children, high ketone levels are associated with severe emotional distress. There is a risk of developing ketoacidosis in pregnant women.

What do deviations in analysis results indicate?

Ketones are formed during the breakdown of fats. This is a kind of intermediate product, which then goes to the kidneys and completely disintegrates there. In the opposite situation, when the enzyme is not further processed, it accumulates in the body and becomes dangerous due to its toxicity. At the same time, the appearance of acetone in a baby’s urine is not always a serious pathology. For example, minor jumps can be observed in children actively involved in sports.

Even a slight load on the immune system or digestive problems can cause such a reaction. In general, it is children under 12 years of age who are at risk for ketonuria. This is due to a deficiency of glycogen - glucose, which is processed in the liver. The activity of children leads to the fact that all glucose is broken down, and enzyme deficiency occurs. Hence the sharp increase in ketones in the urine. In addition, excessive consumption of fats and protein foods can become provoking factors.

Non-pathological causes

When ketones in the urine are elevated, a specific ammonia odor appears. The reason for this may be the physiological characteristics of the development of the body or lifestyle. Such factors are considered to be non-pathological, that is, they do not pose a serious threat to health and are not considered signs of illness. These include:

1. Daily physical activity. This is especially true for children involved in active sports.
2. Prolonged, incessant crying.
3. The child is tired, there are signs of overwork.
4. Incorrectly formulated diet. The cause of metabolic disorders can be the abuse of fatty, spicy, salty foods. The phenomenon of ketonuria is often provoked by food with copious amounts of dyes. Thus, oversaturation with fatty foods can cause an acetonymic crisis.
5. Insufficient volume of fluid consumed per day.
6. Hot weather.

Signs of the disease caused by the above factors quickly disappear if the source is eliminated. If within five days the level of ketones remains the same, we are talking about pathological processes. Immediate assistance from a specialist is required.

Diabetes

Diabetes mellitus is a serious pathology in which not only the level of ketones in urine increases, but also a sharp jump in glucose occurs and sugar appears in the blood. Insulin deficiency occurs. This occurs due to the fact that glucose reserves are reduced to zero, and “sugar” starvation begins.

For further life activity, the body begins to look for a source of strength and energy. As such it takes fats. It is during the breakdown of fats that ketones are formed. Systematically checking urine ketone levels is a way to control diabetes.

In diabetes mellitus, the problem of acetonuria can only be solved by artificially administering insulin. If the disease is not kept under control, a serious complication of ketoacidosis develops, in which ketones in large quantities are not excreted from the body, wander and poison.

Other pathologies

The appearance of acetone in the urine cannot always be explained by a simple lack of carbohydrates. There are often more serious reasons. These include:

• infectious diseases accompanied by high fever;
• intoxication of the body associated with worms;
• intestinal infections accompanied by profuse vomiting and diarrhea;
• liver diseases, including impaired enzymatic function of the organ;
• problems with the endocrine system;
• head injuries;
• anemia, characterized by abnormal breakdown of red blood cells;
• malignant and benign tumors.

Causes of ketonuria

An increased level of acetone in the urine may indicate both temporary disruptions of certain processes in the body and a serious pathology. Traces of ketones are found in the urine of adults and children against the background of the following conditions:

• fasting and long-term diet;
• violation of fat and carbohydrate metabolism;
• intense physical activity;
• hypothermia or heatstroke;
• developing anemia;
• viral and infectious diseases;
• diabetes;
• hematopoiesis disorder, blood leukemia;
• neoplasms in the brain;
• oncological diseases of the gastrointestinal tract;
• intoxication with salts of heavy metals;
• taking certain medications;
• vomit;
• chronic alcohol dependence, leading to destructive changes in the liver.

The reason for the appearance of KET in a urine test can be a low-carbohydrate diet, prolonged fever, poisoning and infectious intestinal diseases.

Patients after surgery are also at risk, since the breakdown of blood proteins in the wound surface increases, and anemia resulting from blood loss can aggravate the process. Ketones in the urine can appear due to insufficient fluid intake, as well as when eating large amounts of animal products.

But this is not a complete list of reasons why ketone bodies may appear in the urine. Many other pathologies can cause acidosis, so no conclusions can be drawn without examination and consultation with a specialist.

Pathological causes

1. Diabetes mellitus is the most common cause of ketonuria. This sign indicates the development of a decompensated state. The body cannot cope with the utilization of ketones, so patients develop signs of coma.
2. Hypovitaminosis of cobalamin (vitamin B12) also causes lipid metabolism disorders. Typically, the pathology occurs against the background of damage to the mucous membrane of the stomach and intestines, as well as helminthiases (worms partially absorb vitamins). A similar condition develops in people with severe forms of anemia or cancer.
3. In chronic alcoholics, ketonuria is observed with damage to the liver and pancreas. In addition, alcoholism aggravates the deficiency of vitamins that are involved in metabolism. Acetone also appears in acute poisoning with alcohol and other toxic substances.
4. Glycogenosis is characterized by impaired accumulation and utilization of glycogen, which prevents the maintenance of normal glucose levels. In patients with Gierke's disease, there is insufficient release of glucose from the liver into the blood, so the use of lipids is increased to compensate. The disease is accompanied by metabolic acidosis and ketonuria. In congenital Pompe disease (glycogenolysis type 2), there is a malignant accumulation of glycogen and acetone. The disease is incurable, so children die in infancy.

Separately, it is worth mentioning about hereditary aglyconosis, in which there are no glycogen deposits. The disease is compatible with life, but children need frequent feeding, as they have a tendency to morning hypoglycemia and increased acetone levels, which are accompanied by cramps and vomiting.

Physiological reasons

• When ketone bodies appear in the urine, the reasons are sometimes associated with dietary errors. With a fatty diet, carbohydrates practically do not participate in metabolism, so fats are intensively oxidized. The body can adapt to such an extreme situation if the diet is introduced gradually and lasts several days. Under these conditions, the muscles and nervous system are able to break down huge amounts of ketones. However, if you suddenly switch to a high-fat diet, ketosis occurs.
• The causes of acetonuria are also associated with hunger. The second period of fasting begins from the second week, when the amount of amino acids in the body decreases, breakdown products increase, the concentration of ketones and their consumption by the brain occur.
• In a child, acetonuria is caused by malfunctions of the pancreas. During the formation of all systems and organs, the gland cannot cope with harmful factors. When the gland is dysfunctional, biochemical processes do not provide the secretion of enzymes to digest fatty or protein foods.
• In women expecting a child, ketones accumulate during severe toxicosis. This indicates that vomiting leads to loss of water from the body. The situation is complicated by the restructuring of the immune system and the psycho-emotional state of the expectant mother. Ketones in excess amounts are toxic to the developing fetus, so their concentration in the mother's body should be kept to a minimum.

Interesting! During hunger, ketones cover 70% of the energy needs of the brain, being an alternative to glucose.

Prevention measures

If a child’s acetone is elevated, it means that undesirable processes are occurring in his body. In this case, long and unpleasant treatment is required. Therefore, parents should direct every effort to prevent the occurrence of such a problem. Among the basic rules of prevention are:

• Get your child used to a normal daily routine. There must be a proper balance between activity and rest. Make sure your baby doesn't get overtired.
• Show your son or daughter that sports are fun and interesting. Moderate physical activity strengthens the immune system and helps cope with diseases.
• The child should spend a lot of time outdoors. Take him out into nature whenever possible.
• Vitamins help remove excess acetone. If the child does not get enough of them from food, he will need to take medications. The choice of a specific product and its dosage can only be made by a specialist.
• Make sure your child always dresses appropriately for the weather. It should not be overcooled or overheated.
• Carry out hardening. At an early age, this can be sun and air baths, and at an older age, cool water is used for this. Regular procedures will help increase the body's resistance to various diseases.
• Take your baby to the pediatrician regularly. Systematic medical examinations will help to identify and treat all health problems in a timely manner.

If your child’s breath smells like acetone or other negative symptoms appear, immediately seek help from a doctor. It is important to find out why this happened and begin therapy as soon as possible. Self-medication in such a situation is dangerous for the life of a small patient.

Dangers of ketoacidosis and ketonuria

Elevated ketones can be an indicator of inflammation in the body. In diabetes, reports incorrect insulin therapy, insufficient insulin doses, or a critical decrease in blood glucose. Ketoacidosis is dangerous not only as an indicator of more serious diseases, but also by its presence alone. Because of it, the alkaline-acid balance is disturbed towards an acidic environment. The heart rhythm may be disturbed (arrhythmia), problems with blood circulation, respiratory or cardiac arrest, disturbance of consciousness, coma.

Approaches to treating the condition

Elimination of acetonemic crisis

If the symptoms of a crisis appear for the first time, then you need to call your local doctor at home. He will decide whether it is possible to be treated at home or whether hospitalization is necessary. If the symptoms are not very pronounced, then you should immediately try to replenish the sugar supply in the body. To do this, you need to offer your child sweet tea or another drink with honey or sugar, glucose solution or compote. Moreover, drink 1-2 teaspoons every few minutes so as not to cause a gag reflex. To remove excess ketones from the blood and urethra, an enema is given and a course of enterosorbents is prescribed. If the child has developed an appetite, you should give him food that is easy to digest. The drug “Enterofuril” is considered effective in increasing acetone. With its help, ketone is quickly removed from urine and blood.

Treatment of acetone syndrome

After the symptoms of the crisis are relieved, everything possible should be done to prevent the syndrome. If a crisis occurs once, then you need to do all the tests and undergo research to identify the causes. If symptoms recur periodically, then adjustments to the child’s lifestyle and diet are needed. When symptoms of acetonemia accompany every infectious disease, you need to consult a doctor to prevent the problem. It is important to treat with acetone, since neglect of the disease will lead to complications.

Which specialist should I go to?

When the first symptoms of acetonemia appear, you should immediately call your local pediatrician at home. He must examine the child and make a preliminary diagnosis. If the doctor deems it necessary, he will prescribe the necessary laboratory tests. After this, you will need to consult an endocrinologist and gastroenterologist. These highly specialized specialists will carry out the necessary manipulations and make the final diagnosis.

Diet food

If a child has symptoms of acetone in the urine and the diagnosis is confirmed, then you need to immediately switch to dietary nutrition. On the 2nd day after diagnosis, you are allowed to eat a baked apple, homemade crackers or biscuits. Rice water is suitable as a drink. On the 3rd day, you can add mashed potatoes diluted with liquid or rice porridge to the menu. On the 4th day, you should prepare a light vegetable soup. During the week you need to add boiled and chicken meat, oatmeal and kefir to your diet. The diet for acetonemia strictly prohibits smoked foods, fresh fruits and vegetables, chocolate, baked goods, fatty and salty foods, sour cream, store-bought sauces and carbonated water. This diet will help remove acetone from the urine and prevent recurrence.

How to determine ketone bodies in urine?

The easiest way to detect ketone bodies is to do a urine test. The most commonly used samples are:

• Lange;
• Legal;
• Lestrade;
• Rothers;
• express tests using photometric test strips: Uriket, Ketofan, Ketoglyuk, Diafan.

For analysis, urine is collected in a clean, dry container, after which a test strip with a special reagent is immersed in the material being tested. The color is then compared with a special color scale. If ketones are detected, the color of the strip changes to purple - the intensity depends on the concentration of acetone.

Another way to quantify ketones in the blood is possible using FreeStyle Optium Ketones test strips and a FreeStyle Optium glucometer.

How is the presence of ketonuria detected?

If symptoms appear indicating that the acetone content may have increased, this is a reason to consult a doctor. Only he can make a final diagnosis and prescribe adequate treatment.

1. Make sure that the child's liver does not increase in size. This can be done by ordering ultrasound examinations or even through palpation.
2. Conduct laboratory tests of blood and urine. With acetonemia, a lack of glucose will be detected in the blood, and acetone will be found in the urine.

There is also a way to diagnose acetonemia using a rapid test. This method can be used even at home. To do this, use special strips impregnated with a composition that reacts to acetone. To carry out the analysis, you need to dip the strip into urine collected in advance and compare its color with the samples that are available on the packaging in which the tests are stored. If the test confirms suspicions, more in-depth studies described above are carried out.

Ideally, a child’s urine should not contain ketone bodies at all. However, it is believed that the norm of acetone in a child’s urine is plus 0.5-1.5 mmol/l. 2 mmol/l already indicates the beginning of the development of pathology. A concentration of 4 to 10 mmol/l indicates that the child has moderate acetonemia, which requires complex treatment. If the readings exceed 10 mmol/l, the child’s condition is serious and he needs urgent hospitalization.

Diagnosis is the most important element in the treatment of acetonuria. To correctly assess the effectiveness of treatment measures, tests are recommended to be done every three hours.

Diagnostics

Diagnosis of ketone bodies in urine is an important medical study that allows one to identify the level of acetone intoxication in the body. Ketonuria in an advanced state can cause serious harm to a person, therefore, when acetone is detected in the urine, it is important to establish the exact cause of this pathology.

The final interpretation of a general urine test in the presence of ketone bodies should only be carried out by a doctor. Methods for diagnosing the presence of acetone in the body include not only a urine test, but also a blood test, thanks to which it will be possible to determine a more accurate level of ketone bodies in the blood.

Based on additional laboratory tests, the doctor will be able to determine whether diabetes mellitus is the reason why ketones were detected in the urine, or whether this pathology arose against the background of another disease.

The cut-off value, which serves as an indication for further monitoring of the patient's condition, is determined at the level of 0.5 mmol/l in blood tests. A reading above 1-2 mmol/l will indicate long-term intoxication with ketones.

To confirm the diagnosis of diabetes mellitus, in addition to a general study of the level of ketone bodies in the urine and blood, a blood test for glucose is performed. If the determination of glucose levels does not show an excess of the norm, you will need to look for another cause of the pathology.

What is the reason for the appearance of ketone bodies?

Often the body experiences a lack of carbohydrates. Sometimes glucose is poorly absorbed. This leads to excess ketones in urine. For each organism the reason is always individual:

• large interval between breakfast, lunch and dinner;
• long-term diet;
• lack of interest in food;
• stress, increased physical activity;
• consequences of injury or surgery, exacerbation of protracted ;
• infection of the body;
• lack of insulin in diabetes mellitus;
• the predominance of protein foods and fats in the menu.

Expert opinion

Kovaleva Elena Anatolyevna

Doctor-Laboratory Assistant. 14 years of experience in clinical diagnostic services.

Ask a question to an expert

In some cases, the reason is quite common - improper collection of urine for laboratory testing. In any case, there is no need to worry right away; there is a reasonable explanation for everything.

Indicators of general urine analysis

A general or clinical urine test is usually called a study that allows one to evaluate in the laboratory the physicochemical characteristics of the biological environment and microscopic residues in it. Through this study, it is possible to diagnose a number of pathological conditions in the early stages of development.

When examining urine, the following indicators are assessed:

• Color. Normal urine is straw-yellow in color. A change in its color (light or dark urine) may indicate dysfunction of the liver tissue. If it has a red color ('meat slop'), then they speak of an admixture of blood (kidney pathology, massive destruction of red blood cells). Black urine indicates the presence of a hereditary disease - alkaptonuria.
• Transparency. Normally, urine is clear. Its cloudiness can be caused by the presence of pus, red blood cells, and mucus.
• Smell. Has a non-specific odor. If there is a bright, pungent odor, one may suspect the presence of some pathological process occurring in the body. Ammonia smell - cystitis, acetone - the formation of an increased amount of ketones, fetid - the presence of a purulent process, cabbage or fish - a violation of amino acid metabolism.
• Acid-base balance. Normally, urine is acidic.
• Relative density. Normal values ​​are from 1010 to 1018. An increase in this indicator indicates dehydration of the body, a decrease indicates kidney pathology.
• Foaminess. Usually this property is weakly expressed. If there is a large amount of colored foam, it may indicate liver pathology.
• Protein. Normally it should not be in the urine. The appearance of protein may be a sign, for example, of nephropathies, any pathological processes in the urinary tract, or systemic connective tissue diseases.
• Urobilinogen. It is a product of bilirubin metabolism. The norm is 5-10 mg/l.
• Cylinders, bacteria, salts, fungal mycelium. Absent in normal conditions. Their presence indicates a pathological process.
• Leukocytes. For women, the norm is 0-5 in the field of view, for men – 0-2. The readings above indicate an inflammatory response.
• Red blood cells. The norm for men is 0-1 in the field of view, for women – 0-3. Changes in indicators indicate pathology of the urinary tract and changes in the blood system.
• Epithelium. For both men and women, the norm is 0-10 in the visual field. Exceeding these indicators indicates the presence of an inflammatory process.

Classification

Since the detection of ketones in the urine of a child indicates the development of a pathological condition, acetonemic syndrome is also considered to be not a disease, but a symptom. Depending on the pathologies that caused metabolic disorders, acetonemic syndrome is divided into 2 types:

• primary (of unknown origin or idiopathic);
• secondary (pathological).

The primary syndrome should be considered as an independent disease, resulting from a neuro-arthritic diathesis (neuro-arthritic abnormality of the constitution). Children with this tendency are characterized as:

• overly excitable;
• overly active;
• emotional;
• inquisitive.

In addition, with this condition, the following disorders associated with genetic predisposition are noted in the child’s body:

• insufficient enzymatic function of the liver;
• disorders of fat metabolism;
• carbohydrate metabolism disorders;
• endocrine disorders;
• disorders of uric acid metabolism.

Diathesis is a consequence of genetic disorders and is a non-standard reaction of the body (abnormal) to ordinary stimuli.

Neuro-arthritic diathesis should not be confused with redness of the skin in a child (allergic diathesis)

Secondary syndrome is a consequence of an existing acute condition or pathology. As a rule, the cause that provoked the development of acetone syndrome is easy to determine and treatment tactics can be developed aimed at eliminating the root cause of ketoacidosis.

Pathological conditions that can cause ketoacidosis include:

• diabetes;
• postoperative condition;
• infectious diseases.

Laboratory tests and home tests

The first time ketones are detected in urine is in the laboratory; for further monitoring at home, you can purchase test strips at the pharmacy.

In the laboratory analysis form, ketones are designated ket, but on the contrary their absence or presence and concentration are indicated. Normally, ketone bodies should not be detected in urine. And the presence of acetone is indicated by “+”, mmol/l, or mg/dl.

1. + weakly positive result, traces of ketone bodies are present in the urine. Their concentration is less than 20 mg/dl. With such indicators, treatment is carried out at home.
2. + and ++ positive result, condition of moderate severity. Concentration is about 35 mg/dl. Treatment can be carried out at home, but always under the supervision of a doctor. If you feel worse, go to the hospital.
3. +++ strongly positive result. The amount of ketone bodies is 10 mmol/l, or more than 80 mg/dl. And this poses a threat to life and requires immediate intervention by doctors in a hospital setting.

Determination of ketone bodies in urine at home is done using test strips. The principle of their operation: when contacted with acetone, the strips become colored. The brightness of the color depends on the concentration of ketones.

To conduct the study, urine is collected, then strips are dipped into it. The degree of coloring of the strip is compared with the scale on the packaging, and the result is deciphered.

Even if ketone bodies were detected once, it is better to purchase test strips and use them at the slightest suspicion. Most often, this condition appears in children under 12 years of age and pregnant women, and is associated with poor nutrition. In this case, it is enough to replenish fluid in the body and a diet that restores carbohydrate balance. Electrolyte solutions are used to remove acetone. You need to drink them in small portions every ten minutes. If such a condition occurs in a pregnant woman in the second half of pregnancy, it may indicate a serious complication - gestosis, or the presence of diseases. Additional tests and medical supervision will be required.

Acetonuria is a condition that requires monitoring and adequate treatment. And to be sure that it is not associated with serious diseases, you must visit a specialist and undergo a series of examinations.

What to do if ketones are detected

If a positive test result is detected at home, you should consult a doctor for advice.
The doctor must identify the cause of the acetonemic condition and give further recommendations. You should not delay going to the hospital, since with a significant increase in acetone in the blood, the child may lose consciousness or become lethargic and apathetic. Sometimes, on the contrary, hyperexcitability develops. A pronounced smell of acetone can be heard from the mouth. The skin becomes covered with cold sweat and noisy breathing occurs. These symptoms indicate a complication of the disease and require immediate hospitalization in a medical facility. If the general condition is not impaired, is not associated with diabetes mellitus and the test strip showed the level of acetone in the urine up to 2 mmol/l, you can combat the symptoms at home. The child should be given a large amount of warm, sweet drink (at the rate of 100 ml per kilogram of weight). Or give Glucose, which is sold in bottles (40, 10 and 5%), one teaspoon every 5 minutes. You can also give raisins or grapes.

If the condition worsens, treating the child at home can be life-threatening. The hospital carries out a set of detoxification measures aimed at removing acetone from the body. Further, in accordance with the etiology, the following treatment is prescribed:

1. For decompensated diabetes mellitus, insulin is administered in a dose of 10-15 units intravenously as a bolus, followed by 0.1 units/kg body weight/hour. After recovering from an acute condition, the endocrinologist selects the correct glucose-lowering therapy.
2. In case of fever, body temperature can be reduced by prescribing Paracetamol, Nurofen or intramuscular administration of Analgin with Diphenhydramine.
3. Children with hyperexcitability of the nervous system should be prescribed sedatives according to their age.

Also, in the first days after the elimination of the pathological condition, much attention is paid to dietary nutrition. For 12 hours after ketoacidotic syndrome, the child is on parenteral nutrition and consuming sweet compotes and decoctions

Further, it is allowed to consume easily digestible foods, such as: porridge (buckwheat, rice), vegetable soups, fruit jelly.

It is strictly forbidden to eat fatty foods. Along with it, the following are prohibited: sausages, cream desserts, cakes, baked goods, meat broths, fried and spicy foods.

Ketonuria in children

The reason for the detection of acetone in the urine of children is most often overwork, stress, emotional overload, or a long trip. Acidosis also occurs against the background of viral, infectious diseases, intestinal infections, especially if the disease is accompanied by high fever or frequent vomiting.

In addition, ketones in the urine in children under 12 years of age indicate insufficient fluid intake in the body, as well as an incorrect and unbalanced diet.

A temporary and slight increase in the level of ketone bodies in children is easily corrected and most often does not cause serious pathologies.

However, ketonuria in children may also indicate serious disorders in the body, such as a brain tumor, liver failure, diabetes mellitus, and dysfunction of the thyroid gland. Therefore, it is important, when a KET indicator is detected in a child’s urine test, to conduct repeated studies to prevent the development of pathologies.

Why does ketonuria occur in children?

In preschool children, ketones in urine more often appear due to overwork or prolonged stress. The following reasons can also provoke this condition:

• emotional instability;
• long trip;
• infectious diseases accompanied by fever and severe vomiting (especially intestinal);
• unbalanced diet;
• decreased immunity;
• long-term use of antibiotics;
• insufficient fluid intake into the body.

If the increase in the level of ketones in a child’s urine is slight, this most often indicates the absence of pathology and can be quickly corrected. But in any case, when a component is detected, a full diagnosis is required, since the presence of acetone in urine can be a sign of dangerous diseases, for example, diabetes mellitus or thyroid dysfunction.

It is worth considering that most of the symptoms of ketonuria are usually observed against the background of elevated body temperature

Why is ketonuria dangerous?

A strong increase in ketone bodies contributes to the development of an acetonemic crisis, which is characterized by high body temperature, lethargy, profuse vomiting, loose stools and dehydration.

In addition, ketone bodies are a powerful oxidizing agent. This means that they are easily able to enter into chemical reactions with the membrane membranes of cells and destroy tissue, including brain tissue. Very often, after eating during an acetonemic crisis, the body provokes the activation of a protective mechanism - vomiting, in order to prevent an even greater increase in ketones.

Ketone bodies are not only a strong oxidizing agent, but also a strong toxin that causes dehydration, which can impair all vital functions of the body. That is why during a crisis the most important task is to follow a strict diet, feeding the child not only glucose, but also solutions that contain salts and other mineral elements.

Ketones in urine during pregnancy

Normally, a pregnant woman should have no ketone bodies in her urine. If the analysis shows the presence of KET in the urine, most often the pregnant woman will be indicated for hospitalization.

Despite the fact that elevated acetone in a pregnant woman does not always indicate serious pathologies, only with an inpatient examination will doctors be able to find out exactly what this means and why the ket indicator is present in the urine.

Typically, in pregnant women, an excess of the norm of ketone bodies in the body occurs against the background of toxicosis, especially accompanied by frequent vomiting.

Or ketonuria can develop against the background of gestosis (toxicosis of the last trimester) due to hormonal changes and consumption of large amounts of food rich in proteins and fats. In addition, pregnancy and pathology of this kind can be interconnected for the following reasons:

• viral and bacterial diseases;
• diabetes;
• liver damage;
• oncological diseases.

The presence of acetone in urine can be dangerous for a pregnant woman. Ketonuria threatens not only the life and health of the child, but also the mother.

This condition can lead to miscarriage, premature birth and even coma. If a pregnant woman feels unwell, notes severe fatigue, drowsiness, and at the same time she has ketones in her urine, this condition requires treatment in a hospital.

Development mechanism

There are several reasons that trigger the development of acidosis in children:

• stressful situations accompanied by a disruption in the hormonal system;
• eating fatty foods;
• irregular meals, with long “hungry” periods;
• diseases of the endocrine system (thyrotoxicosis, diabetes mellitus).

Regardless of the reasons for carbohydrate deficiency, to replace energy needs, the process of fat metabolism is activated, accompanied by the release of fatty acids from fat “depots”.

All of them enter the liver, transforming into a transition form - acetoacetic acid (acetyl-coenzyme A), which the body partially uses as an energy reserve.

Unused acetoacetic acid undergoes a series of transformations, partially turning into cholesterol and partially into ketone bodies.

An increase in the concentration of acetoacetic acid beyond the permissible values ​​negatively affects the process of its conversion into energy, as it suppresses the activity of enzymes that stimulate its conversion. Ultimately, the body is left with the only possible way to remove acetyl-coenzyme A - the formation of ketone bodies.

The higher the concentration of ketones in the blood plasma, the more difficult it is to normalize energy metabolism, since metabolic disorders are complicated by the toxic effects of acetone on the body.

Ketoacidosis in a child, over time, can lead to the development of gout

Increased acetone content in a child’s urine

The disease occurs much more often in children than in adults, since they have a low amount of glycogen. The process of fat breakdown occurs much faster.

Ketonuria in children can manifest itself:

1. Once. Vomiting occurs with the characteristic odor of acetone. It may be the result of problems with the absorption of fats and carbohydrates. In such a situation, it is necessary to undergo an examination and change the child’s diet, reducing the amount of fats and proteins in it. This condition is very dangerous because it can provoke an acetomic crisis, which is characterized by: high fever, drowsiness, abdominal pain, lethargy, etc.
2. Regularly. It is necessary to immediately undergo a complete diagnosis to exclude possible diseases: brain tumor, diabetes, liver damage and intestinal infections.

Characteristic symptoms:

• Cramping pain in the abdomen;
• Episodic or constant headache;
• Lethargy;
• Nausea;
• Drowsiness;
• General weakness;
• Enlarged liver;
• Heat;
• Dry and pale skin with an unhealthy blush on the cheeks;
• Loss of appetite.

As a rule, children complain of pain localized in the navel area. Also, ketones can be present in the presence of worms in the child’s body, diathesis, dysentery, fatigue and increased stress.

Reasons for increased acetone:

1. Overwork;
2. Flu and other colds;
3. Stress;
4. Unbalanced diet;
5. Long tiring trips;
6. Emotional overexcitement.

The most common reason is an increased amount of fatty foods consumed. The main cause of the disease in newborns is insufficient feeding.

Another type of disease is also known - leucinosis (branched chain ketonuria) . This disease is congenital and occurs in newborn babies, with a frequency of 1/130,000-300,000 cases. It occurs in a very severe form and is fatal.

Types and symptoms of acetone crisis

There are two main types of acetone syndrome: primary and secondary. Secondary is an exacerbation of diseases such as diabetes, toxicosis of an infectious nature, liver failure, hemolytic anemia, hypoglycemia and many others.

Primary is a congenital feature of the body that can be detected already during the first year of a child’s life. Children with the so-called neuro-arthritic anomaly of the body constitution are susceptible to acetonemic crises.

In children with this anomaly, crises and hyperketonemia are repeated repeatedly with the risk of developing into acidosis. What is special about neuro-arthritic anomaly:

• poor sleep from birth, high fatigue and excitability, the nervous system is quickly depleted due to the predominance of excitation processes over inhibition processes,
• lack of oxalic acid in the body,
• deficiency of certain liver enzymes,
• disorders of carbohydrate and fat metabolism,
• disruptions in the endocrine system associated with metabolism,
• dysuria of non-infectious origin.

In some children, for example, during an infection or fever, an acetonemic crisis may appear once, pass quickly and disappear without a trace, never recurring. This may be the child’s individual reaction to mental stress or stress in the postoperative period.

The clinical picture of the crisis is characterized by increased temperature, repeated (sometimes uncontrollable) vomiting, intoxication, dehydration, weakness, enlarged liver, cramping pain in the abdominal area, the presence of a characteristic odor of acetone from the mouth, and hypoglycemia may be observed. Ketones in the child’s urine and blood are greatly increased. Typically, during a crisis, leukocytes, neutrophils, red blood cells and ESR do not rise significantly.

The occurrence of ketonuria against the background of diabetes mellitus

Ketonuria in diabetes mellitus is characterized by an increased amount of acetone in the blood. This process is called ketoacidosis - the presence in the body of carbohydrate metabolism disorders that are not transformed, are broken down into sugar bases and do not take part in fat and protein metabolism.

The cause of the disease lies in insulin deficiency, due to which cells are unable to use glucose as an energy source, which increases the consumption of fat reserves.

Subsequently, an acid shift in the humoral system occurs in the body. Due to the rapid breakdown of fats and a deficiency of alkaline reserves, the amount of acetone in the blood and urine begins to increase. If not treated promptly, diabetic coma occurs.

The presence of acetone in the urine is typical for patients with the first type of disease (DM 1), when the sugar level in the blood reaches 13.5-16.7 mmol/l, and in the urine over 3%.

As a treatment for the disease, carbohydrate metabolism is stabilized and the amount of acetone in the blood is reduced due to:

• Antibacterial therapy;
• Rehydration:
• Insulin therapy;
• Correction of hypokalemia;
• Normalization of acid-base balance.

As a preventive measure for diabetes mellitus, you should constantly keep your glucose level within 12 units (mmol/l).

Physiological reasons

The level of acetone in urine under certain circumstances also increases in a healthy child. In this situation, it is important to find out the reason in time. The following factors have a negative impact:

1. Violation of the principles of proper nutrition. If protein and fatty foods predominate in a child’s diet, then nutrients begin to accumulate due to the fact that they are difficult to process into glucose. Products containing many chemicals: dyes, preservatives, flavors also have a negative effect on the young body.
2. The baby is in a stressful situation, excessive excitability. Often parents ignore this factor, believing that the child is simply capricious. In fact, the mental state greatly affects the functioning of all organs and systems of the body.
3. Overwork. An increase in the dose of acetone in a child’s urine becomes a consequence of unbearable mental and physical overload. They provoke a double consumption of glucose, resulting in its deficiency.
4. Hypothermia. Exposure to low temperatures leads to a slowdown in metabolic processes in the body.
5. Long-term use of antibacterial drugs.
6. Dehydration of the body. This happens during excessive sweating in the heat, after severe diarrhea and bouts of vomiting.

Experts believe that the most common reason for an increase in the amount of acetone in a child’s urine is an illiterate menu. The baby's diet should contain a sufficient amount of fast carbohydrates that can meet the daily requirement for glucose. At the same time, he should receive more vitamins and minerals from fruits and vegetables.

From an early age it is important to teach your child a healthy lifestyle. Do not expose him to stress, mental and physical overload, direct all your efforts to strengthening the immune system.

Treatment methods

The main goal of therapy for ketonuria is to get rid of traces of acetone in the body as soon as possible. Most often, men and women with this diagnosis are prescribed drug therapy, one of the most important stages of which is intravenous infusion with saline solution. If the content of ketones in the urine is not critical, therapy can be carried out at home.

The first thing you need to do to reduce the content of ketone bodies is to carry out detoxification using sorbents and normalize the water balance. The patient also needs to review his diet and adhere to a special diet that will help remove acetone from the body and prevent its further increase.

The diet requires compliance with the following rules:

• the patient needs to minimize the consumption of fatty meat, fermented milk products with high fat content, smoked meats and fast food;
• It is forbidden to eat sweets (chocolate, candies, jam, marshmallows);
• It is strictly prohibited to consume alcoholic beverages;
• It is recommended to remove citrus fruits, tomatoes and mushrooms from the diet.

A person's daily diet should include foods rich in fiber, all kinds of cereals and vegetable soups. Also, for ketonuria, compotes and fruit drinks made from fresh berries and dried fruits are very useful.

Medicines

Treatment with medications involves the use of the following drugs:

• Adsorbents. These include Polysorb, Enterosgel, Polyphepan, Activated Carbon.
• Replenishing fluid in the body. Glucose solutions, saline solution, and Ringer's solutions are used.
• Antiemetic drugs. Metoclopromide, Domperidone, Cerucal.
• To reduce flatulence. Motilak, Motilium.

The appearance of ketobodies in the urine most often indicates the presence of some pathological process in the human body. To detect it early and prescribe appropriate treatment, it is necessary to undergo a more complete examination.

Diet

Dietary nutrition implies the inclusion in the diet of:

• turkey meat;
• rabbit meat;
• beef;
• vegetable broths;
• soups;
• various cereals;
• juices (fruit, berry);
• vegetables, fruits;
• lean fish.

It is prohibited to use:

• alcoholic drinks;
• citrus fruit;
• coffee, cocoa;
• mushrooms;
• confectionery;
• dishes made from fatty fish and meat;
• dairy products with high fat content.

Treatment of acetone syndrome in a child

Treatment of this syndrome should include two components:

• Stimulation of the removal of ketone bodies from the body. Oral rehydration, that is, drinking regime. Moderate drinking of the child and the use of alkaline mineral waters are recommended. Mineral water should be without gas. Do not overdo it; excess fluid will provoke an attack of vomiting.
• Ensuring the supply of the proper amount of sugars. To do this, you can use sweet drinks (tea, compotes), oral glucose solution, and in hospital conditions it is possible to prescribe glucose intravenously.

So, at the first manifestation of the disease, the child is offered to drink in small portions of 2-3 teaspoons, 4-6 times per hour. Use alkaline mineral water and sweet tea. You can buy Regidron solution in pharmacies; this option is more preferable.

Enterosorbents can be used as an additional leverage. In children, the use of the following drugs is indicated:

• phosphalugel,
• enterosgel,
• polyphepane,
• polysorb,
• atoxyl,
• smecta,

For detoxification purposes, cleansing enemas are given with water or two percent soda. In addition, if treatment by soldering is impossible, alkaline enemas are used to restore the volume of fluid in the body.

For indomitable vomiting and severe symptoms of dehydration, treatment includes intravenous infusion.

The volume of liquid received during the day orally and by infusion is obtained at the rate of 100-120 ml/kg of the child’s weight.

Consequences of ketonuria

Delayed treatment leads to a number of consequences:

1. Heart arythmy.
2. Circulatory disorders.
3. Cardiac or respiratory arrest.
4. Acetone crisis
5. Disorders of consciousness.
6. Brain swelling.
7. Respiratory disorders.
8. Death.

Ketones are very strong oxidizing agents that can destroy any tissue.

Possible complications

According to statistics, after 12 years of age, acetone does not rise in the urine of a child. This is due to the improvement of the child’s enzyme system. But with frequent acetonemic crises, side disturbances in the functioning of other organs and systems of the body can develop. These include increased blood pressure, kidney and liver disorders, joint diseases and diabetes. To monitor the level of ketones in a child's urine, it is checked using test strips. If the values ​​increase, you should consult a doctor and try to reduce the high level.

Recommendations for patients

Children are very active, so their energy expenditure is higher than that of adults. However, due to biological characteristics, the child’s body experiences a constant glucose deficiency. Parents should be concerned about their children's diet and provide meals rich in simple and complex carbohydrates.

To prevent ketonuria in people who play sports, it is recommended to establish a daily routine and consult a doctor about proper nutrition. Prevention of helminthic infestations and hardening of the body will also help avoid the appearance of ketone bodies in the urine.

Since increased acetone during pregnancy causes negative consequences for the developing fetus, the expectant mother needs to learn how to eat during toxicosis and drink small sips of water. For the first episode of acetonuria, consultation with a doctor is mandatory. It is necessary to undergo an examination, blood biochemistry, and urine tests. It is important to exclude serious diseases that caused ketonuria.

Treatment

Treatment of acetone syndrome in children is carried out taking into account existing pathological and physiological disorders and includes the following areas:

1. Limiting fat intake.
2. Enrichment of the diet with carbohydrates.
3. The use of enzymes that improve the absorption of carbohydrate foods - cocarbaxylase, vitamin B1, vitamin B6.
4. Intravenous infusion of sodium chloride (has a rehydration and alkalizing effect), glucose (eliminates carbohydrate deficiency).
5. Use of antibiotics (as indicated).

If the concentration of ketone bodies does not exceed 500 mg/l and is not accompanied by serious disorders, such as repeated vomiting, the prescription is limited to diet therapy in combination with drugs that have a rehydration effect (Regidron).

Solutions of sorbitol or xylitol are highly effective in treating ketosis, since the process of converting them into energy occurs differently from glucose

If a child is suspected of having a neuro-arthritic abnormality of the constitution, dietary restrictions should be observed, meal times should be systematized, and long breaks between meals should be avoided. Upon reaching the age threshold of 12-14 years (puberty), the risk of developing acetonemic crises will disappear.