II. Mechanism

  1. 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. Blood (preferred)
      1. Beta-Hydroxybutyrate
        1. Best 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: Positive

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

V. Causes: False PositiveKetones on Urinalysis

VI. Causes: False NegativeKetones on Urinalysis

  1. Delayed urine exam

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