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Ketones in urine

Ketones are intermediate breakdown products of fat (See Ch. 14). Ketones appear in urine during starvation. Presence of ketones in urine in presence of high blood glucose indicates severe diabetes. Persons with type 1 diabetics are more prone to pass ketones in the urine than their type 2 diabetic peers. Accumulation of ketones in the blood gives rise to ketosis. Ketosis prone diabetics should learn to test urine for ketones.

Urine should be tested for ketones when a person with diabetes develops nausea, vomiting or becomes drowsy or if the urine contains large amount of glucose or if the blood glucose level is very high, more than 270 mg/dl. It is also done if a diabetic sustains severe injury or undergoes a major operation and during pregnancy. Presence of more than 'traces' in urine indicates an imminent or an established diabetic ketoacidosis making administration of insulin mandatory. There is no point in testing urine for ketones when urine glucose test is negative or shows a trace, except during pregnancy.

URINE KETONES TEST

Paper strip test

Material: Complete kit is supplied by the manufacturer.

Method: Dip the reagent end of the strip in urine and withdraw it immediately. Note the colour of the tip of the strip after 15 seconds. A purple colour indicates a positive test.

This test does not detect all types of ketones. It gives a false positive test when the patient is taking drugs like captopril and a false negative test when the strips have been exposed to air.

Other urine tests

Testing the urine of a diabetic for only glucose is not enough. Protein appears in urine in urinary infection or when diabetes has affected the kidneys. The significance of ketones in the urine of a diabetic has already been discussed. Urine should also be tested for white cells (to look for urinary infection) and casts (to look for kidney involvement). With the help of a special paper strip, urine can be tested for protein, glucose and ketones at the same time.

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Ketones in urine