Urine Ketone

Aka: Urine Ketone, Urine Ketone Test Strip

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II. Mechanism

  1. Urine Dipstick detects acetic acid (Acetoacetate)
    1. In Diabetic Ketoacidosis, Beta-Hydroxybutyrate (primary Ketone) is converted to Acetoacetate
  2. Confirmatory Test
    1. Urine
      1. Acetest tablet test
    2. Serum Ketone (preferred)
      1. Beta-Hydroxybutyrate
        1. Preferred Serum Ketone test
      2. Basic chemistry panel
        1. Ketoacidosis
          1. Low serum bicarbonate
          2. Increased Anion Gap
        2. Normal or resolving Ketoacidosis
          1. Normal serum bicarbonate
          2. Normal Anion Gap

III. Interpretation: Normal

  1. Negative

IV. Causes: True Positive Urine Ketones

  1. Dehydration
  2. Starvation or Low Carbohydrate Diets (Ketogenic Diet)
  3. Diabetic Ketoacidosis (DKA)
  4. Alcoholic Ketoacidosis
  5. Isopropanol toxicity
  6. Pregnancy

V. Causes: False Positive Urine Ketones

  1. Low Urine pH (acidic)
  2. Increased Urine Specific Gravity
  3. Phenolphthalein
  4. Levodopa

VI. Causes: False Negative Urine Ketones

  1. Delayed Urine Exam
  2. Not all Ketones (Beta-Hydroxybutyrate, Acetoacetate, Acetone) are detected by all Urine Dipstick tests
    1. Most Urine Dipsticks detect Acetoacetate

VII. References

  1. Hitzeman (2022) Am Fam Physician 106(1): 27-35 [PubMed]
  2. Simerville (2005) Am Fam Physician 71(6): 1153-62 [PubMed]

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