You might be a little worried when you hear that you have ketones in your urine, right? But don't worry. Let's talk about this simply and clearly. What are these ketones? Why are they in our urine? Let's understand all this in detail today.
What are these ketones in urine?
Simply put, ketones are a byproduct of your body's inability to use the sugar, glucose, that your body uses to produce energy. It's like burning wood in a wood-burning stove, leaving behind ash. These ketones are produced when our bodies break down fat for energy. They're actually a type of acid. Like other chemical byproducts in our bodies, ketones eventually pass out of our bodies in our urine. But sometimes they can also be found in our blood. Having ketones in your urine is medically known as 'ketonuria.'
Now think about it, it's normal to have some ketones in your urine, that is, a small amount . There's nothing to worry about. Because sometimes our bodies have to use fat for energy. For example, when we're sleeping, if we fast for a day, or if we're on a low-carb diet, that is, a ``Keto Diet'' that many people talk about.
However, if the amount of ketones increases, it is dangerous . Because then the acidity of our blood increases. We call this condition `Ketoacidosis`. This is especially true for people with diabetes, which is why it is called `Diabetes-related Ketoacidosis (DKA)`. This condition called DKA is a medical emergency that can be life-threatening , so if you suspect it, it is essential to seek medical attention immediately.
How do you measure ketones in urine?
Okay, so how do we know exactly if there are ketones in this urine, and if so, how much? There are two main ways to do this.
At-home tests
You can buy these ketone test strips at a pharmacy or online. They are available over-the-counter (OTC), meaning they don't require a prescription from a doctor. All you have to do is collect some of your urine in a clean container, dip the strip in it, leave it for the time specified by the manufacturer (usually a few seconds), and then take it out. The strip will change color. The strip comes with a color chart. You need to compare the color of your strip to the color chart. It usually indicates your ketone levels as 'negative', 'trace', 'small', 'moderate', or 'large'. These strips are most commonly used by people with diabetes and those on the `Keto Diet`.
Medical tests
Sometimes your doctor or nurse can check your ketone levels with a urine test, called a urinalysis. But if you have symptoms of ketoacidosis, your doctor will likely order a blood ketone test . This blood test is more accurate than a urine test. It also shows the exact amount of ketones in your body at that time. A blood test usually gives an exact number instead of a range.
Here's something else to understand. It takes our bodies a while to produce urine. So a urine test won't give you an exact measure of your ketone levels right away. However, it can give you a rough idea of what your ketone levels have been like over the past few hours.
Why do ketones appear in our urine?
Now let's look at why these ketones appear in our urine. The body mainly prefers to use `glucose` or sugar to provide energy to every cell in our body. We get this glucose from the carbohydrates we eat, that is, starchy foods. However, in some special cases, our body is forced to burn fat (sometimes even muscle) for energy.
If you don't get enough carbohydrates , or if you don't have enough of the hormone insulin, which helps your body use glucose , your body goes into a state called ketosis. In this state of ketosis, the body burns fat for energy, and ketones are released as a byproduct. They are eventually excreted in the urine.
When ketones occur normally
Even simple things like sleeping or fasting for a day or two can cause the body to enter a state of ``ketosis'' and produce trace amounts of ketones in the urine. This can be considered normal and healthy.
Similarly, ketosis occurs when you follow a `Ketogenic diet` or the `Keto diet` as it is popularly known among many. This keto diet is mostly high in fat, moderate in protein, and very low in carbohydrates. To be precise, a typical keto diet is about 70% - 80% fat, 20% protein, and 5% - 10% carbohydrates. Ketones are usually seen in the urine of people who follow a strict keto diet.
Causes of abnormally high ketone levels in urine
But if you have small, moderate, or large amounts of ketones in your urine, it could be abnormal . There are several reasons for this:
- Diabetes: We all need a hormone called `Insulin` to survive and use glucose for energy. If you have diabetes, your body either doesn't produce insulin, doesn't produce enough, or can't use the insulin it produces properly. This causes glucose to build up in the blood, leading to high blood sugar levels. At the same time, without insulin, the body can only use fat for energy. If the lack of insulin continues, ketones will build up in the body. This can lead to the life-threatening condition called `diabetic ketoacidosis (DKA)` mentioned earlier.
Just think, if a person with diabetes doesn't take their medication properly and doesn't inject insulin, their blood sugar levels can get out of control in a few days, leading to a dangerous situation like this. Therefore, people with diabetes need to be very careful about this.
- Alcohol use disorder: When you drink alcohol excessively over a long period of time, it can affect the way your body absorbs nutrients like carbohydrates and stores glucose in the liver (as glycogen). This forces your body to burn fat instead, which can lead to a condition called alcohol-related ketoacidosis. Like DKA, this can be a life-threatening condition.
- Pregnancy: The main cause of ketones in the urine during pregnancy is ``Gestational diabetes.'' However, all of the other causes on this list can also cause ketones during pregnancy.
- Prolonged vomiting and/or diarrhea: If you have been vomiting or having diarrhea for a long time, your body may run out of glucose for energy and ketones may appear in your urine. Imagine a small child who has a stomach ache for several days and is constantly vomiting and not eating. This is what can happen.
- Eating disorders and starvation: Some eating disorders, such as anorexia, and prolonged fasting can limit the amount of carbohydrates and glucose your body can absorb. This can also cause ketones to appear in your urine.
- Prolonged, intense exercise: When you exercise for a long time and intensely, if all the glucose stored in your body (glycogen) is used up for energy, your body will start burning fat. This can also cause ketones to appear in your urine.
Can someone without diabetes have ketones in their urine?
Yes, you can have 'trace' or 'small' amounts of ketones in your urine even if you don't have diabetes. This can sometimes be normal, especially if you are fasting or following a keto diet. However, it is unusual for someone without diabetes to have 'moderate' or 'large' amounts of ketones in their urine. If this happens, call the 1990 Suwaseriya Ambulance Service in Sri Lanka immediately, or call the emergency number in your area , or go to the nearest emergency room. You may have undiagnosed diabetes or another serious medical condition.
What are normal and dangerous ketone levels in urine?
What is a normal ketone level?
It is considered normal and safe for most healthy people to have 'trace' or 'small' amounts of ketones in their urine.
However, if you have diabetes or another condition that puts you at risk for ketoacidosis, even this level can be a warning sign . For example, if your blood sugar level is above 250 mg/dL (high blood sugar), it is important to monitor your blood sugar levels closely and continue to test your urine for rising ketone levels.
What is a dangerous ketone level for someone with diabetes?
Any ketone level above 'small' or 'trace' can be dangerous, especially if you are at risk for 'ketoacidosis' (e.g. diabetes).
- If you have small amounts of ketones in your urine, it increases your risk of ketoacidosis. If you have diabetes, talk to your diabetes doctor or healthcare provider about how to manage this condition.
- If you have moderate or large amounts of ketones in your urine, you are at high risk of developing ketoacidosis. This is an emergency, so seek medical attention immediately at your nearest hospital.
What does it mean to have 'trace' ketones in the urine?
A 'trace' level of ketones in the urine is generally a safe and healthy level for people without diabetes. Most people can have small amounts of ketones in their urine, especially first thing in the morning.
Can the presence of ketones in the urine cause symptoms?
Yes, if you have ketones in your urine, you may experience other symptoms depending on the amount of ketones.
Symptoms of Ketosis
The state of ``Ketosis,'' which is when small amounts of ketones are normally present in the urine (e.g., when on a keto diet), can cause symptoms like these in some people:
- Feeling like you have an upset stomach, nausea
- Headache
- Fatigue
- Brain fog, difficulty concentrating
- A distinctive odor coming from the mouth ('keto breath')
- Constipation
- Insomnia
Symptoms of Ketoacidosis
Moderate or high levels of ketones in your urine mean you may have a condition called `ketoacidosis` – also known as `DKA` or `alcoholic ketoacidosis`. This is very dangerous.
Early symptoms of DKA may include:
- Frequent urination
- Excessive thirst, dry mouth (polydipsia)
- Excessive hunger (polyphagia)
- Dehydration
- Headache
More severe symptoms of DKA and alcoholic ketoacidosis may include:
- Nausea and vomiting
- Severe stomach pain
- Diarrhea
- Difficulty breathing or `Kussmaul breathing` (deep, rapid, labored breathing)
- Fruity-smelling breath (acetone smell)
- Feeling extremely tired or weak
- Decreased consciousness, agitation, or confusion (altered mental status)
- Decreased ability to stay awake, drowsiness
If you have one or more of these symptoms, consider it a medical emergency and seek immediate medical attention, as this can be life-threatening!
The most important things you need to remember
Ketones, in small amounts, can be part of a normal process in our bodies. However , if ketones accumulate in large amounts in the body, it can be a serious condition that can be life-threatening. Especially if you are at risk for `ketoacidosis`, that is, if you have a condition like diabetes, talk to your doctor about how to properly manage it. Also, talking about what to do if your ketone levels get too high, and having a good plan, will help protect you from danger. It is very important to always take care of your body, your health, and be aware, do you understand?
` Ketones, ketones in urine, ketoacidosis, DKA, diabetes, keto diet, urine test
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