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What is ketonuria?

Ketonuria happens when you have high ketone levels in your urine. This condition is also called ketoaciduria and acetonuria.

Ketones or ketone bodies are types of acids. Your body makes ketones when fats and proteins are burned for energy. This is a normal process. However, it can go into overdrive due to some health conditions and other reasons.

Ketonuria is most common in individuals who have diabetes, particularly type 1 diabetes mellitus. It can also occur in women who are pregnant or breastfeeding.

If ketone levels rise too high for too long, your blood becomes acidic. This can harm your health.

Ketogenic diet

Ketonuria is a sign that your body is primarily using fats and protein for fuel. This is called ketosis. It’s a normal process if you’re fasting or on a low-carbohydrate, ketogenic diet. A ketogenic diet does not typically pose a health risk if it’s done in a balanced way.

Low insulin levels

Most of the energy your body uses comes from sugar or glucose. This is normally from the carbohydrates you eat or from stored sugars. Insulin is a vital hormone that transports sugar into every cell, including your muscles, heart, and brain.

People with diabetes may not have enough insulin or be able to use it properly. Without insulin, your body can’t efficiently move sugar into your cells or store it as fuel. It must find another power source. Body fats and proteins are broken down for energy, producing ketones as a waste product.

When too many ketones pile up in your bloodstream, a condition called ketoacidosis or diabetic ketoacidosis can occur. This is a life-threatening condition that makes your blood acidic and can harm your organs.

Ketonuria usually happens along with ketoacidosis. As ketone levels rise in your blood, your kidneys try to get rid of them through urine.

If you have diabetes and have developed ketonuria, you likely also have high blood sugar levels, or hyperglycemia. Without enough insulin, your body can’t properly absorb sugar from digested food.

Other causes

You can develop ketonuria even if you don’t have diabetes or are on a strict ketogenic diet. Other causes include:

  • drinking excess alcohol
  • excessive vomiting
  • pregnancy
  • starvation
  • illness or infection
  • heart attack
  • emotional or physical trauma
  • medications, such as corticosteroids and diuretics
  • drug use

Ketonuria may be a sign that you have ketoacidosis or leading to it. The higher your levels of ketones, the more severe the symptoms and the more dangerous it can become. Depending on severity, signs and symptoms can include:

  • thirst
  • fruity smelling breath
  • dry mouth
  • fatigue
  • nausea or vomiting
  • frequent urination
  • confusion or difficulty focusing

Your doctor may find related signs of ketonuria:

  • high blood sugar
  • significant dehydration
  • electrolyte imbalance

Additionally, there may be signs of illnesses such as sepsis, pneumonia, and urinary tract infections that can lead to high ketone levels.

Ketonuria is commonly diagnosed through a urine test. Your doctor will also look at your symptoms and medical history.

Common tests for ketones in both your urine and your blood include:

You may also undergo other tests and scans to look for the cause:

Home tests

The American Diabetes Association advises checking your ketone levels if you have diabetes, particularly when your blood sugar is more than 240 milligrams per deciliter. You can test for ketones with a simple urine test strip.

Some home blood glucose monitors also measure blood ketones. This involves pricking your finger and placing a drop of blood onto a test strip. Home tests may not be as accurate as a urine or blood test in your doctor’s office.

Test ranges

Regular ketone testing is very important if you have diabetes. Your urine test strip will change color. Each color corresponds to a range of ketone levels on a chart. Whenever ketones are higher than normal, you should check your blood glucose level. Take immediate action if needed.

Under 0.6 millimoles per literNormal urine ketone level
0.6 to 1.5 millimoles per literHigher than normal; test again in 2 to 4 hours
1.6 to 3.0 millimoles per literModerate urine ketone level; call your doctor immediately
Above 3.0 millimoles per literDangerously high level; go to the ER immediately

If your ketonuria is due to temporary fasting or changes in your diet, it will likely resolve on its own. You won’t need treatment. Test your ketone levels and your blood sugar and see your doctor for follow-up appointments to make sure.

In more serious situations, ketonuria treatment is similar to treatment for diabetic ketoacidosis. You may require lifesaving treatment with:

  • fast-acting insulin
  • IV fluids
  • electrolytes such as sodium, potassium, and chloride

If your ketonuria is due to illness, you may need additional treatment such as:

  • antibiotics
  • antivirals
  • heart procedures

In serious cases, ketonuria may lead to complications that impact your health. It can result in a coma or death.


Diabetic ketoacidosis is a health emergency that can lead to a diabetic coma and even death. The spike in ketones in your blood raises your blood’s acid levels. High acid states are toxic to organs, muscles, and nerves and interfere with bodily functions. This condition can happen to anyone with diabetes, but it’s most common in people with type 1 diabetes.


High blood sugar levels, which lead to high ketone levels, significantly increase urination and can lead to dehydration. Illnesses that cause ketonuria may also cause nausea, vomiting, and diarrhea adding to dehydration.

In pregnancy

Ketonuria is common even in a healthy pregnancy. It may happen if you don’t eat for a long period of time, have a low-carbohydrate diet, or experience excessive vomiting.

Expectant mothers who have diabetes or gestational diabetes are at greater risk for ketonuria. This can lead to ketoacidosis, which can harm the developing baby.

If you have gestational diabetes, your doctor may recommend treatment through diet and medications such as insulin. Treatment usually resolves ketonuria. You will still need to monitor your blood sugar levels and ketone levels regularly throughout pregnancy and after the birth of your baby.

Your doctor or nutritionist will recommend changes to your diet. The right food choices are an important step in the management and treatment of gestational diabetes.

Ketonuria can be caused by many factors, including what you eat. It may be due to an imbalance in your diet or have a more serious cause. See your doctor immediately if you think you have ketonuria.

The most important key to treatment is identifying the cause. In many cases, you may be able to prevent it. Avoid extreme diets and talk with your doctor or nutritionist before making drastic changes in your daily diet.

Ketonuria may be a warning sign that something’s wrong. If your symptoms include confusion, headache, nausea, or vomiting, seek emergency medical care.

If you have diabetes, ketonuria is a warning sign that your diabetes isn’t in control. Check your ketone levels as often as you check your blood glucose levels. Record your results to show your doctor.

Talk with your doctor about what you can do to balance your blood sugar levels. Your doctor may prescribe insulin or other medications. You may need the help of a dietician to help guide your food choices. Educators on diabetes can also help you manage and understand your condition.