Ketonuria is a condition categorized by high levels of ketones in the urine and this condition is also called ketoaciduria and acetonuria. Ketones are the kinds of acids that the body produces when fats and proteins are used for energy. It is a normal process but can go into overdrive due to some health problems and other reasons. Ketonuria is quite common in individuals with type 1 diabetes mellitus. It can also develop in pregnant or lactating women. If the ketone levels increase high for a longer period, then the blood may become acidic, which eventually can harm the health status.

Also Read: Diabetic Ketoacidosis: Causes, Symptoms And Treatment

What Are The Causes Of Ketonuria?

Ketogenic Diet

Ketonuria is an indication that the body is chiefly using fats and protein for energy. This is called ketosis and it is a normal process if you’re fasting or on a low-carb, ketogenic diet. A ketogenic diet does not typically pose a health risk if it’s done in a systematic and balanced way.

Low Insulin Levels

Our body uses sugar or glucose as the main source of energy. This is from the carbs a person eats or from a stored form of sugars. Insulin is the main hormone that transports sugar into every cell, including muscles, heart, and brain. People with diabetes may not have sufficient insulin or be able to use it well. Lack of insulin, the body cannot use sugar as energy or store it as fuel, Thus, body fats and proteins are broken down for energy, producing ketones as a waste.

When excess ketones start accumulating in the bloodstream, this condition is called ketoacidosis or diabetic ketoacidosis can develop. This is a critical condition that makes the blood acidic and damages vital organs. Ketonuria typically occurs along with ketoacidosis, As ketone levels rise in the blood, kidneys try to eliminate them via urine.

Also Read: Why The Keto Diet Is More Than Just A Weight-Loss Programme

Other Causes

  • Drinking excess alcohol
  • Excessive Vomiting
  • Pregnancy
  • Starvation
  • Illness
  • Infection
  • Heart attack
  • Physical trauma
  • Medications, such as corticosteroids and diuretics
  • Drug use

Symptoms Of Ketonuria

Ketonuria is a sign that a person has ketoacidosis or developing it. The higher levels of ketones, the more serious the symptoms and more harmful they can become. Depending upon the severity of the condition, signs and symptoms can include:

  • Thirst
  • Fruity smelling breath
  • Dry mouth
  • Fatigue
  • Nausea
  • Vomiting
  • Frequent urination
  • Confusion

Further, the healthcare provider may find related signs of ketonuria:

  • Uncontrolled blood sugar
  • Severe dehydration
  • Electrolyte imbalance
  • Sepsis
  • Pneumonia
  • Urinary tract infection


Ketonuria is usually diagnosed through a urine test. The healthcare provider will look out for the symptoms and medical history of the patients. Some of the common tests for ketones in both urine and blood include:

  • Finger-stick ketone blood test
  • Urine strip test
  • Acetone breath test 

Additional tests and scans are also suggested to look for the cause:

  • Blood electrolytes
  • Complete blood count
  • Chest X-Ray
  • CT scan
  • Electrocardiogram
  • Blood culture tests for infections
  • Blood glucose test
  • Drug screen

Home Test

The American Diabetes Association recommends checking ketone levels if the blood sugar level is more than 240mg/ dl, with help of a simple urine test strip. Home blood glucose monitors also check blood ketones which involve pricking fingers and placing a drop of blood onto a test strip. However, home tests may not be as accurate as urine or blood test done in a lab.

Test Ranges

The urine test strip will change colour, each colour relates to a range of ketone levels on a chart. Whenever ketone levels are higher than normal, one should immediately check blood glucose levels and take prompt action.

Range                           Results

Under 0.6 mm/litre:    Normal urine ketone level

0.6 to 1.5 mm/litre:     Higher than normal; repeat test in 2 to 4 hours

1.6 to 3.0 mm/litre:     Moderate urine ketone level; consult your doctor immediately

Above 3.0 mm/litre:    Dangerously high level; get immediate hospital care


Ketonuria caused due to temporary fasting or alteration in the diet pattern, and it will most likely settle on its own. You wouldn’t require any treatment. However, in more severe cases, ketonuria treatment is quite similar to diabetic ketoacidosis and may need lifesaving treatment with:

  • Fast-acting insulin
  • Intravenous fluids
  • Electrolytes infusions such as sodium, potassium, and chloride
  • If your ketonuria is due to illness, then additional treatment such as:
  • Antibiotics
  • Antivirals
  • Heart procedures