Ketone bodies in urine - causes and treatment of ketonuria

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.

Methods for determining ketonuria: how is diagnosis carried out?

To find out whether a patient has traces of ketone bodies, it is necessary to take a urine and blood test for biochemical testing. The increase in acetone and protein are determined by urinary secretions. And hematological results make it possible to see changes in other indicators, such as glucose, cholesterol, lipoproteins.

To assess the condition of urine, a strip test is used. They are produced for express diagnostics at home and for laboratory, more thorough testing. The difference between a clinical examination is that in addition to assessing the biochemical, physical and chemical properties of the discharge, specialists examine the urine sediment under a microscope, which gives a broader picture of the patient’s health status.

In laboratory conditions, daily urine is used. That is, the patient collects discharge for the whole day. They become a reliable source of information about changes in the body. At home, they resort to studying one-time urination in the morning.

Home methods for determining ketonuria are made with indicator test strips. The color becomes more intense if high concentrations of acetone are present in the urine. There is a color scale on the packaging, based on which you can find out the level of acetonuria.

Using keto strips is very simple and convenient:

1. The patient must first clean the perineum thoroughly to avoid contaminating the collected material.
2. He then collects the urine in a clean container.
3. Takes the keto strip out of the jar and immerses it in the secretions for 2 seconds so that the indicator zone is completely in the liquid.
4. If there is a lot of urine left on the strip, carefully remove it by running it along the wall of the test container (not the side with the indicator).
5. Once the test area is colored, you can compare the results to the color chart sticker on the jar.

Manufacturers usually produce tubes with three degrees of interpretation, which are designated by pluses. If the patient shows a single plus sign, it means that the discharge contains 0.5-1.5 mmol/l of ketone bodies. The next scale is the average severity of acetonuria (about 4 units). And three pluses indicate high numbers - approximately 10 mmol/l.

Ketone test strips can be used by people without any medical knowledge. They are sold without a prescription in all pharmacies. There are many manufacturers offering express diagnostics of urine at home, so each person can choose the most suitable or inexpensive option.

It is important to remember that test strips behave unpredictably when treated with certain medications. If the results seem unreliable - overestimated or underestimated, it is better to retake the analysis again in the laboratory.

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.

Ketone bodies in the blood. What are the causes of excess formation of ketone bodies in the body?

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Ketone bodies are acids formed during lipid metabolism. Let's learn everything there is to know about these substances, which can accumulate in the blood or urine and affect the entire body.

What are ketone bodies

Ketone bodies are organic acids formed in the liver during lipid metabolism.

There are three molecules in our body that are usually produced in small quantities called ketone bodies.

The three ketone bodies that are present in the blood are:

Acetoacetic acid and beta-hydroxybutyric acid are actually ketone bodies that are formed to compensate for the lack of energy molecules before the body begins to use amino acids (the building blocks of proteins).

These two molecules are essentially energy carriers that are introduced into the bloodstream by the liver and then used by central organs (such as the heart and brain) to produce energy.

Acetone is quite well known in the field of cosmetology (this liquid is often used to remove nail polish). It is formed during the decomposition of ketone bodies, in particular acetoacetic acid. Acetone then enters the bloodstream and is removed very quickly through breathing.

Where and how are ketone bodies formed?

The production of ketone bodies occurs in liver cells, in particular in mitochondria, which carry out the process of ketogenesis.

During ketogenesis, acetyl-coenzyme A is synthesized, a molecule that is involved in various metabolic processes and is used by mitochondria in the Krebs cycle so that the cell can obtain the energy necessary to perform its functions.

Increased levels of ketone bodies: ketones and ketonuria

There are certain conditions that can cause ketone bodies to accumulate in the blood and appear in the urine:

• Very high-fat, low-carb diet: When carbohydrate intake is low, the body uses fat, resulting in excess production of ketone bodies
• Prolonged fasting: when sugar reserves are depleted and the body begins to consume fats and proteins
• Intense physical activity
• Glucogenosis: a group of inherited diseases in which, due to a deficiency of certain enzymes, the body is unable to use glycogen
• Uncompensated diabetes. In this case, the lack of insulin prevents the proper use of glucose in the blood, which stimulates the use of fat reserves

Consequences: ketoacidosis

If the situation with elevated levels of ketone bodies does not last long and only happens occasionally, the body removes the ketone bodies and restores proper functioning in the shortest possible time.

With a prolonged increase in the level of ketone bodies, an acid-base imbalance in the blood develops, such as acidosis, i.e. excessive acidity of the blood and dehydration of the body.

Symptoms of ketoacidosis

At first, all symptoms are quite mild:

• increased urine production (to eliminate excess ketone bodies), leading to dehydration
• increased breathing rate
• sweating
• nausea
• fever
• Bad breath – breath smells like nail polish

Dehydration leads to an increase in the concentration of potassium in the blood, which causes heart rhythm disturbances.

Therapy: How to Balance Ketone Body Levels

If ketoacidosis is not caused by a disease, then treatment consists of changing the diet to one rich in fiber and carbohydrates and taking fluids, which compensate for dehydration and promote the excretion of ketones in the urine.

In the case of diabetic ketoacidosis, it is necessary to administer an intravenous solution of electrolytes such as sodium, potassium, phosphate and chloride, which replenish the deficiency caused by excessive diuresis.

Controlling glucose levels with insulin and introducing electrolytes allows, in most cases, to restore the acid-base balance and correct excessive acidity of the blood, and only in case of coma, it is necessary to resort to additional treatments.

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.

What causes acetonuria?

During normal metabolism in urine, ketone bodies are not detected, since the body extracts the glucose it needs from incoming food. A person also receives this carbohydrate during the breakdown of glycogen, a substance that is stored and stored in the liver. In pathological processes and lack of glucose, the body has to extract it from the fat depot. As a result of the destruction of fat cells, a large amount of acetone products is released into the blood. After passing through the kidney tubules, these substances end up in urine. The appearance of ketone bodies in urine is often a consequence of metabolic processes, namely carbohydrate and fat metabolism.

The reasons for the increase in the level of these substances in the patient’s secretions are as follows:

1. Pregnancy - in this case, the formation of ketone products is due to toxicosis. If the developing fetus lacks glucose, the mother's body may sacrifice fat reserves to provide the nutrients the unborn child needs.
2. Malignant tumors of the hematopoietic organs - with leukemia and leukemia, a huge amount of energy is spent. The disease progresses rapidly and weakens the patient's body.
3. Diabetes mellitus - in such patients, an increase in ketones in the urine often indicates the severity of the disease. If the levels of these substances increase to ten mmol, signs of hyperglycemic coma may soon appear.
4. Neoplasms of the thyroid and adrenal glands - damage to the endocrine glands leads to an imbalance of hormones. In this case, ketone substances begin to appear in urine due to the acceleration of fat metabolism in the body, which is a consequence of an increase in the amount of corticosteroids in the blood. In case of development of thyrotoxicosis in men and women, excessive consumption of glucose is observed.
5. Insufficient intake of carbohydrates from food - when losing weight, abusing protein foods, fasting and dieting, ketone bodies can also be detected in a urine test.
6. Liver pathologies cause dysfunction of this organ (chronic alcoholism).
7. Inflammatory and tumor processes of the gastrointestinal tract - lead to an increase in ketone bodies in the urine due to a lack of nutrients. In such situations, the absorption of carbohydrates, proteins and fats is impaired.
8. Bacterial and viral infections - such diseases often occur with high fever, which requires high energy costs.
9. Severe intoxication - in this situation, traces of ketones in the urine indicate poisoning with heavy metals or atropine.

Under normal conditions, glucose consumption can increase sharply in case of hypothermia or heavy physical labor. But its daily levels usually range from 5 mg to 15 mg. With such a low amount of acetone, no changes in a person’s well-being are noted.

Important! Symptoms of ketonuria often affect women who experience a long-term lack of carbohydrates, are on special diets or are starving. For men, this problem arises when engaging in exhausting sports - bodybuilding, weightlifting. In such a situation, ketone bodies in the urine are often a logical consequence of enormous energy expenditure, rather than some kind of pathology.

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.

How to treat ketonuria during pregnancy

Having understood the origin of the pathology, the doctor chooses therapy that will help reduce the level of ketones in the urine.

In a number of situations, elevated ketone bodies can be eliminated without medication—a diet is enough; in other cases, medications are needed.

Diet and lifestyle

Fatty, fried, canned foods are the first things you will have to give up if a woman is diagnosed with ketonuria. The restriction will not seem harsh when unhealthy foods are replaced by a variety of healthy ones, for example:

• vegetable soups based on low-fat meat or fish;
• turkey, chicken, rabbit meat stewed, baked or boiled;
• lean fish - cod, flounder, trout, prepared in similar ways;
• porridge, preferably with water; in first place are whole grain porridges, rich in so-called slow carbohydrates, which take longer to digest than usual; as a result, the blood is saturated with glucose not in jumps, but gradually, which eliminates the processing of excess substances into fats;
• low fat cottage cheese;
• vegetable dishes;
• cracker;
• fruits other than citrus fruits.

Photo gallery: what to eat for a pregnant woman with ketonuria

Oven-baked turkey is an excellent replacement for fatty pork

Buckwheat porridge contains slow carbohydrates that the body needs during ketonuria

Low-fat cottage cheese will complement the menu as a representative of dairy products

Vegetable stew is a hearty and healthy dish, the main thing is not to fry the vegetables

Cod is a low-fat fish and is suitable for a diet for ketonuria.

Apples and other fruits will replace unhealthy sweets

To reduce the amount of glucose in the body, women with diabetes should say a decisive “no” to sweets, soda, full-fat milk and eggs. But for those who “earned” ketonuria by exhausting themselves with fasting, food with carbohydrates is not prohibited.

Drink enough water - one and a half to two liters per day - to avoid dehydration . If you are vomiting, you need to replenish fluid losses; to do this, drink clean water and green tea; take small sips, drink slowly, so as not to cause a new attack of vomiting.

Eliminate bad habits from your life (alcohol, smoking, drugs) - they are generally not compatible with pregnancy, and in case of ketonuria they additionally poison the body.

Get out into the fresh air more often, if your health allows: strengthen your immune system, drive away depression.

When it's time for medicine

If you are severely dehydrated, drinking plenty of fluids is no longer enough; The water-salt balance is disturbed, calcium, magnesium, and sodium salts are washed out of the body, without which organs and systems are not able to function fully . The expectant mother needs help in the form of rehydration solutions, which are drunk at the first symptoms of dehydration (severe weakness, dizziness). Among these means:

• powder for preparing Regidron solution;

  
  Regidron solution helps to quickly restore the water-salt balance in the body depleted by dehydration

• Gastrolit powder;
• tablets that dissolve in water, Glucosolan.

In principle, treatment with solutions is safe, but still consult a doctor before use; It is forbidden to drink the same Regidron if you are severely dehydrated, otherwise the woman’s condition will worsen.

In case of severe ketonuria, the pregnant woman is admitted to the hospital; standard treatment is IVs . The following compounds are introduced into the body:

• glucose (for those who do not suffer from diabetes) - to resume energy activity;
• vitamin complexes - to provide the fetus with useful substances;
• magnesia (magnesium sulfate) - to lower blood pressure;
• saline solution - includes chlorine and sodium ions, clean water; not contraindicated for pregnant women, does not even cause allergies; helps remove toxins and replenish mineral reserves.

To remove toxic substances from the body, safe sorbents are used - Enterosgel, Smecta; drugs effectively absorb toxins - including ketone bodies - and then remove .

Enterosgel belongs to the sorbents that are safe for pregnant women and free the body from toxic substances.

To treat pathologies that cause increased levels of ketone bodies in the urine, the patient is, in particular, prescribed:

• antibiotics that are relatively safe for pregnant women - to combat pathogens in the body;
• drugs to lower glucose levels or insulin - for pregnant women with diabetes;
• thyreostatics - medications that reduce the excessive production of thyroid hormones - in case of thyrotoxicosis.

When the expectant mother suffers from severe vomiting and is unable to eat normally, the doctor occasionally chooses treatment with the antiemetic drug Cerucal. The product helps:

• reduce the sensitivity of the nerves that transmit impulses to the vomiting center located in the brain;
• improve intestinal motility.

The problem is that Cerucal is forbidden to be used in the 1st trimester - just when toxicosis, the main culprit of vomiting, is rampant in the body of the expectant mother. However, the eruption of vomit is also accompanied by a number of pathologies in the later stages, when Cerucal can be used - but only when there is a threat to the life of the mother or fetus.

The medicine is administered intravenously in a hospital setting to monitor the condition of the pregnant woman.

Sometimes drug therapy, even in a hospital setting, does not produce results; then the doctors offer the patient to agree to an early birth .

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.

Interpretation of results

Ketone bodies can be present in urine in negligible amounts, so laboratory tests usually do not detect them. As a variant of the norm, the content of ketone bodies in a single morning portion of urine is allowed to be no more than 1 mmol/l.

In most laboratories, a qualitative response is represented by reactions: weakly positive, positive or strongly positive.

Factors influencing the result

• Violation of the shelf life and delivery of biomaterial to the laboratory (within 9 days after collection, the concentration of ketone bodies increases significantly);
• Violation of the rules for collecting urine (the entry of bacteria into the collected biomaterial makes it unsuitable for testing within 24 hours);
• Violation of storage conditions (temperature more than 20°C leads to the disappearance of about 20% of ketone bodies within 24 hours);
• Taking medications during the test (captopril, levodopa, etc.);
• Acidification of urine (increased acidity in the TAM) also leads to a false positive result for ketones.

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.

How is ketonuria diagnosed?

Several methods are used to diagnose ketone bodies in urine. The choice depends on the severity.

1. Using test strips to test urine for ketone bodies. Urine is collected in a sterile container. There are no foreign objects or microorganisms inside, so the results will be reliable. Dip one strip into the urine and immediately remove it. The indicator is painted in a color corresponding to the scale on the packaging. It is used to identify the amount of ketone. It is necessary to do tests daily; if a positive result is repeated, the patient consults a doctor.
2. General urine analysis. Using it, the doctor determines not only the content of acetone in the urine, but also other indicators whose values ​​in a healthy person are zero or close to it: leukocytes, red blood cells, protein, mucus. Together with all the data, the doctor will make the correct diagnosis.
3. Daily diuresis, that is, the amount of urine collected per day. Allows you to determine the amount of fluid passed through the kidney filtration system.
4. Determination of blood glucose. Its increase, together with ketone, causes diabetes mellitus, which gets worse with an increase in blood sugar levels. Ketones in urine when glucose levels are normal are caused by other causes.

Signs that indicate an increase in ketone bodies in urine

There are general signs of illness, for which it is not clear what disease caused them, but they are present in acetonuria:

• malaise: weakness, fatigue, dizziness;
• thirst accompanied by dry mouth;
• dyspeptic symptoms: nausea, vomiting.

Signs that will lead a doctor to a diagnosis of ketonuria:

• smell of acetone from the mouth;
• hepatomegaly (enlarged liver);
• intoxication with an increase in temperature to a state of severe fever;
• severe dehydration;
• frequent urination;
• neuralgia; convulsions, headache, coma.

Important! If a person develops ketonuria, the symptoms are present together. Coma occurs when acetone enters the brain.

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.

Diagnosis and treatment

Using test strips to detect ketone levels is the optimal solution for testing at home. To identify it, you need to place the strip in a container with urine, and then observe its coloring: depending on the amount of ketones, coloring occurs with different intensities. However, the most productive way to obtain a diagnosis will be a laboratory test.

The treatment process depends on the cause of the disease. First of all, the patient should try to get rid of this cause. In some cases, this is quite simple, for example, if ketones were formed due to starvation (strict diets), then you need to start eating right. In addition, it is best to take a blood test and find out whether the body has enough carbohydrates, since they are directly involved in the processes occurring in the liver, and if they are deficient, the level of ketones increases.

You also need to follow a healthy lifestyle - exercise, but without overexertion, sleep 8 hours a day and eat right. A healthy diet is the key to a healthy body: eliminate unhealthy foods, eat more vegetables, soups, drink natural juices and compotes. Divide your diet not into 2-3 meals, but into larger quantities. To do this, you can reduce portions, but eat 5-6 times a day, with snacks of fruits and salads. It is also better to avoid foods that are too salty and peppery and reduce the amount of spices used in cooking. It is advisable for diabetics to arrange a “fasting day” for themselves at least once a week, and, if necessary, adjust the insulin dose.

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 are ketone bodies?

These components appear in the process of natural exchange. They first enter the human blood and then, after renal filtration, end up in urine. Ketones in urine indicate the presence of only three chemicals in the secretions - β-hydroxybutyric acid, acetoacetic acid and acetone, which are components of fatty acids. These metabolic products appear in urine after the release of glucose.

When all the patient’s organs are functioning normally, ketone bodies are not excreted in the urine, but are completely inactivated. They break down into elements necessary for the body - carbon dioxide, water. An increased content of such components in the patient’s secretions is called ketonuria. In laboratory tests, this indicator is denoted by the English words trace or ket. Acetonuria can occur in an adult or child at any age.

If ketone bodies are found in the urine, what does this mean? Every day, the body of a healthy person secretes up to 50 mg of acetone products. These substances are excreted in full, so it is almost impossible to determine them in urine. The norm for ketones in urine is considered to be 0 – 0.05 mmol. The amount of these components is measured in millimoles.

An increase in the content of these substances in secretions affects a person’s well-being. The patient's condition changes as follows:

• 0-0.05 mmol is a small amount of ketone bodies and is considered normal;
• 0.05-1.5 mmol – mild severity, symptoms of pathology appear slightly;
• 1.5 -4 mmol – moderate severity, the patient experiences most of the main clinical signs;
• 4-10 mmol – severe, characterized by the presence of the main symptoms of the disease, which are complemented by other dangerous disorders.

Good to know! If tests indicate an increase in the level of ketones in the urine, the specialist will recommend that the patient undergo a more thorough examination of the body, prescribe appropriate medications and follow a special diet.

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

Signs and symptoms

Primary manifestations of ketonuria are usually nonspecific.

Patients complain of cutting pain in the lower abdomen, loss of appetite, slight increase in body temperature , and possible nausea or even vomiting .

At later stages, patients develop weakness, dryness and pallor of the skin, combined with an unhealthy blush , and a distinct smell of acetone from the mouth and from natural secretions is noticeable.

Acid poisoning can cause disorders of the nervous system: from drowsiness and convulsions to coma.

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.

What does it mean to detect ketone bodies in urine?

In a healthy person, urine has a constant chemical composition, which can change within acceptable limits during the day. When inflammatory reactions or tumor processes occur, the performance of organs decreases, which affects urine parameters. If pathology develops, atypical substances appear in the discharge, and the quantitative content of normal components noticeably increases or decreases.

Ketones in urine are formed as a result of the metabolic process. They are secreted by the liver during the breakdown of lipids and the release of energy. If ketone bodies are found in the urine in sufficiently large quantities, the patient is diagnosed with acetonuria or ketonuria.

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.

Symptoms

The first signs of the presence of ketone bodies in the urine are nonspecific: high fever, nausea, vomiting, abdominal pain, loss of appetite. It's more like an intestinal infection. But as it progresses, other symptoms appear that help to suspect ketonuria.

There are signs of dehydration, severe weakness, and the liver is enlarged. The breath, vomit and urine smells like acetone. Moreover, the smell can be barely noticeable even with high levels of ketones.

In children, the symptoms are the same, but they appear earlier. This is due to less glycogen stores.

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).

Indications for analysis

• Chronic abdominal pain of a spastic nature;
• Headaches, drowsiness, weakness without objective reasons (especially in children);
• Regular eating disorders: nausea, vomiting, diarrhea, lack of appetite;
• High temperature (up to 39°C) for a long period;
• The smell of acetone from the mouth, from saliva;
• Smell of acetone after urination;
• Enlarged liver, pain in the right hypochondrium;
• Paleness and dryness of the skin;
• Thick yellow-white coating on the tongue for several days;
• Nervous excitement, convulsions (indicates an increase in acetone).

Also, a test for ketone bodies is prescribed in the following cases:

• routine screening (general urine analysis) for all patients in the hospital;
• planned analysis when registering pregnant women;
• diagnosis and treatment of diabetes mellitus;
• diagnosis of diseases of the liver and genitourinary system;
• observation of cancer patients with liver, thyroid, and adrenal cancer.

Ketone bodies are tested as part of the OAM. The following laboratory methods are used to determine components:

• Lange test;
• Rothera's test (modified);
• Lestrade and Gerhard test;
• Legal sample (colored).

These laboratory tests are based on the reaction of acetone with sodium nitroprusside. When the level of acetone in the urine increases, the sample turns purple (pink, lilac, etc.). In this case, individual data can detect ketonuria from 50 mg of ketone bodies in 1 liter of urine.

The interpretation of the test for ketone bodies and the diagnosis of ketonuria is performed by a general practitioner, nephrologist, gynecologist, urologist, oncologist, pediatrician and family doctor.

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

Therapy is aimed at eliminating the cause of the appearance of acetone in the urine.

As first emergency aid, it is recommended to eliminate intoxication and give the patient a sorbent solution .

Note! It is better to stop eating at first; stick to the diet in subsequent days. If these measures do not help, contact the clinic for IV fluids.

Diet

Fasting is strictly contraindicated . Meals should be frequent, small portions. It is recommended to drink non-carbonated mineral water (preferably alkaline).

When acetone appears in the urine, it is advisable for patients to reduce their carbohydrate intake and increase the amount of protein-containing foods.

The diet must include fresh vegetables and fruits, soups with vegetable broth, porridge, low-fat cottage cheese, kefir, yogurt and fermented baked milk .

Pork, beef, lamb or veal are not recommended. Preference should be given to white meat, chicken, turkey or rabbit.

completely give up bread and sweet confectionery products ; you can sometimes add biscuits to your diet.

The following are prohibited: citrus fruits, mushrooms, bananas, coffee, cocoa, chocolate, tomatoes, sorrel , as well as fast food products (crackers, canned food, chips, carbonated drinks with dyes).

Medications

The patient's condition can be improved by drinking enterosorbents , which remove toxins from the body. Among the most popular and effective are Regidron, Phosphalugel, Polysorb, Sorbex, Smecta, White Coal, Black Coal and Enterosgel.

In more complex cases, treatment consists of taking antibacterial drugs insulin injections (for diabetes), correcting hypokalemia and restoring acid balance.

The course of treatment is selected by the doctor based on the general clinical picture and the patient’s condition.

Body cleansing procedures

Sweet herbal tea with lemon also does a good job of restoring water balance .

If you have an intestinal disorder and colic in the abdomen, you can give cleansing enemas with the addition of sodium bicarbonate .

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.

Prevention

After the course of treatment has been completed, it is important to monitor your body. Monitor your ketone levels regularly at home—with special tests available over the counter, it's easy. Also, if you know that your body is predisposed to such a problem, visit your doctor regularly, especially if you have diabetes. Don't stop watching your diet and don't ignore recurring signs of illness. The consequence of refusal of treatment can be an acetonemic crisis, in which a toxic effect is exerted on most internal organs. It is quite difficult to cure such an advanced condition, so it is better to start fighting ketones immediately, preventing their amount from increasing in the body.

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.

General information

Ketone bodies are a group of metabolites that are secreted in the liver and participate in the body's energy metabolism. These include 3 substances:

• beta-hydroxybutyric acid is a metabolic product that is formed during the oxidation of fatty acids. Re-oxidation occurs in peripheral tissues, where beta-hydroxybutyric acid becomes acetoacetic acid;
• acetoacetic acid is a mobile, colorless substance with an oily consistency, which, when slightly heated, breaks down into carbon dioxide and acetone;
• acetone is an organic component that is always present in the body in small doses. In daily urine it should not exceed 0.01-0.03 g.

Ketone bodies are toxic products of the breakdown of fat cells, and therefore must be neutralized and filtered. These processes occur in the liver, and very quickly, so ketone bodies practically do not reach the kidneys. In the case of a violation of the mechanism and rate of metabolism, the neutralization of ketone bodies by the liver slows down, resulting in the development of ketonuria (increased content of ketone bodies in the urine).