Hey, Good to see you here  …… In this Article, We’re going to discuss the Ketonuria test – the ketone bodies in Urine and how to identify that in Detail… If you have any queries, don’t forget to mention in Comments… Thanks

What Are Ketones?

 Ketones are water-soluble Molecules that are produced by liver when there’s not enough glucose (sugar) for energy.

 Ketones can show up in blood or Urine. It is normal to have a small amount of ketones in your body.

What Is Ketonuria?

 Ketonuria is the High-level excretion of Ketone Bodies in urine. It is also known as ketoaciduria and Acetonuria.

 This usually happens along with Ketoacidosis, a condition when too many ketones pile up in your bloodstream.

 As ketone level rise in your blood your kidney try to get rid of them through urine.

What Are Ketone Bodies?

 Ketone bodies are water-soluble Molecules that contain the ketone groups produce by the Liver.

 There are 3 ketone bodies produced by the Liver. These include :

• Acetoacetate
• Beta- hydroxybutyrate
• Acetone

 These are toxic acidic chemicals which are built up in the blood and then spill over into the Urine.

 The presence of Ketone bodies in blood is termed as ketosis and presence of Ketone bodies in Urine is termed as Ketonuria.

What are the Causes of Ketonuria (Ketone Bodies in Urine)?

 Ketonuria is most Common in individual having TYPE 1 DIABETES MELLITUS.

 You can develop ketonuria even if you don’t have diabetes. Other causes of a ketonuria include:

• Drinking excess alcohol
• Pregnancy
• Drug use
• Starvation
• Excessive vomiting
• Illness of infection
• Emotional or physical trauma
• Heart attack
• Extreme exercise
• Medicine such as steroids
• Dietary imbalance (High fat/ Low carbohydrate diet)

What are the symptoms of a ketonuria?

 Ketonuria may be a sign that you have ketoacidosis.

 The higher your Ketone level the more severe the Symptoms.

 Depending on the severity, sign and symptoms can include:

• Thirst
• Fruity smelling breath
• Dry mouth
• Fatigue
• Nausea or vomiting
• Frequent urination

 Your Doctor may find related sign and symptoms of ketonuria-

• High blood pressure
• Significant dehydration
• Electrolyte imbalance

Additionally, there may be sign of illness such as – UTI (Urinary Tract Infection), Pneumonia.

What are the tests used to identify Ketones in Urine?

 Ketone urine test measures the amount of ketone in the urine.

 You can get the test done in the Laboratory or at your home.

 Methods for detection of Ketone bodies in urine are-

• Rothera’s test
• Ferric chloride test
• Reagent strip test

What are the objectives of Identifying Ketones in Urine?

 The test is often used to help monitor people at a higher risk of developing Ketone.

 This includes TYPE 1 DIABETES (Patient can’t produce Insulin) Or TYPE 2 DIABETES (Patient can’t respond to Insulin).

 If a person has too many ketones, they may be at a risk of developing Diabetic Ketoacidosis (DKA), a complication of diabetes that can lead to Death or Diabetic coma.

What is the Principle of Ketonuria (Ketone in urine) Test?

 The Ketone urine test detects Acetoacetic acid and Acetone in urine.

 The principle of the Ketone urine test is that the Keto group of Acetone and Acetoacetic acid reacts with Alkaline Nitroprusside to a purple colored complex.

Based on the colour intensity, the qualitative or quantitative analysis of ketone in urine can be done.

How to prepare the patient/person for the Ketone bodies in urine test?

Being a healthcare provider/ Laboratory Technologies, you have to give proper instructions to the patient to get the accurate report for the test.

Communicate with the patient that you may need to fast for at least 8-12 hours before the test.

Also discuss, If you are taking any medications or special foods/supplements/diet plans or have any other disorders, please discuss with your doctor for the suitable guidelines for the test.

What is the Procedure of Ketonuria (Ketone in Urine) Test?

 Before the test procedure, you have to guide the patient for a clean catch sample. The steps are as follows :

 Ask the patient to clean his/her hands properly before the sample collection.

 Then, the genital areas and the urethral opening should be cleaned properly with water.

 Educate the patient that, as you’ll start urinating, let the first few drops of urine to flow out in the Toilet Bowl.

 Then, collect a midstream sample in the sterile container provided.

 When you’re done, Close the container immediately and wash your hands.

 Hand over the container to the Health care Provider.

The Procedure of Various tests performed to detect ketone bodies in urine

There are multiple methods available for the detection of Ketone bodies in urine. Below we have described the procedures of 3 most common methods used in the laboratory for the detection of ketone bodies in urine:

Nitroprusside Test (Rothera’s Test to detect ketone bodies in urine)

⇒ Take 5 ml of urine in a test tube with the help of a graduated dropper and saturate it with the Ammonium Sulphate.

⇒ Add a small crystal of Sodium Nitroprusside to the above solution and mix well.

⇒ Now, Slowly run along the sides of the test tube Liquor Ammonia to form a layer.

⇒ Immediate formation of purple permanganate colored ring at the junction of the two fluids indicate a POSITIVE Test.

Ferric Chloride Test (Gerhard’s Test to detect Ketone bodies in urine)

⇒ The addition of 10% Ferric Chloride solution to urine causes the solution to become reddish or purplish, If Acetoacetic acid (a type of ketone body) is present in urine.

⇒ The test is not specific since certain drugs (salicylate & L- dopa) give a similar reaction.

⇒ The sensitivity of the test is 25-50 mg/dl.

Reagent strip Test

⇒ Dip one urine dipstick in the urine container.

⇒ Hold it in the urine for 5-8 seconds

⇒ Take out the strip, remove the excess urine and dry the strip by shaking lightly.

⇒ Observe the colour of the strip, once the strip is dry.

⇒ Observe the colour against the chart that come with the kit.

⇒ Based on the intensity of colour, quantitative analysis of the Ketone Bodies can be done.

What are the Results and interpretation of Ketonuria (Ketone bodies in urine) Test?

The test results may vary depending upon your-

• Age
• Diet
• Sex
• Activity level
• Health history, etc.

NORMAL RESULT – Normal results are expressed as NEGATIVE.

ABNORMAL RESULT – Abnormal result means you have Ketone Bodies in your urine expressed as POSITIVE.

The Various range of Ketone bodies in urine test using Reagent Strip Method are as follows:

Following is the table showing the values of ketonuria test in millimoles/Liter, using reagent strip method: 

Range	Results
Under 0.6 millimoles / L	Normal urine ketone level
0.6 to 1.5 millimoles / L	Higher than normal; Consult your doctor
1.6 to 3.0 millimoles / L	Moderate urine ketone level; Need immediate consultation
Above 3.0 millimoles / L	Dangerously high level; Emergency Situation

What are the uses of Ketonuria test?

The detection of Ketone Bodies in urine is essential as the presence of Ketones in urine can be a Symptom of a more severe condition like toxic Ketoacidosis.

That’s all about the Ketonuria, the detection of ketone bodies in urine … Happy Learning!  

References & Further Reading –

• Science Direct
• VeryWell Health
• Healthline
• Laboratoryinfo

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