What Does Ketones in Your Urine Mean?

Medically Reviewed By Danielle Hildreth, CPT
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While it is natural to have some ketones in your urine, high levels could indicate the body has become too acidic. Your body produces ketones as it breaks down fat for energy. You excrete ketones in your urine. The amount you excrete varies depending on factors such as diet and activity level. Ketone levels also reflect the balance of chemicals in your blood. High ketone levels are toxic to the body.

Treatment for high ketone levels in urine, or ketonuria, depends on how acidic the body is and what is causing it. Ketonuria may be due to a change in diet or an underlying condition, such as diabetes. Medication may be necessary for some causes of ketonuria, such as insulin injections used to manage diabetes.

This article will discuss the causes of ketonuria, including diabetes, along with treatments and ways to prevent it. It will also discuss symptoms that may accompany ketonuria and the ketones in urine test.

The word “diet” can have many meanings. This article uses the term “diet” to refer to an eating lifestyle rather than a temporary change in how you eat. An exception to this usage is the keto diet, which is a diet low in carbohydrates.

Ketonuria explained

urine test strip in palm of hand
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Typically, your body gets the energy it needs from glucose, a type of sugar. Under certain circumstances, your body may not have enough glucose to use for energy. When this happens, it breaks down fat for energy instead. This process creates ketones, or ketone bodies.

Your body removes excess ketones through your urine. However, too many ketones in the urine could indicate a more serious problem.

Ketones are acidic, so high levels can cause your body to become too acidic, which may lead to ketoacidosis. Ketoacidosis is a life threatening condition.

Learn about diabetic ketoacidosis.

Causes of ketonuria

Many conditions can cause your body to break down fat instead of glucose, leading to ketonuria. These conditions fall into two main categories.

Dietary and lifestyle

Ketonuria can be due to insufficient carbohydrates in your diet. Without carbohydrates, your body cannot make enough glucose to meet its energy needs, and breaks down fat instead. The following can lead to ketonuria:

  • keto diet, which is low in carbohydrates
  • fasting
  • excessive exercise at high intensity

Health and medical conditions

Certain health conditions can lead to ketonuria. They include those in which the body cannot metabolize glucose or when there is not enough glucose. Other conditions include:

Symptoms of ketonuria may include:

Symptoms of ketonuria may occur with high blood sugar, defined as more than 300 milligrams per deciliter (mg/dL).

When to see a doctor

Contact your healthcare professional if you experience ketonuria symptoms.

If you have diabetes and experience these symptoms, especially with high blood sugar, call your doctor right away.

If you cannot reach your regular physician, go to an urgent care or get immediate medical attention by calling 911.

What is the ketones in urine test?

Your healthcare professional may use a ketones in urine test to check the level of ketones in your urine. Checking ketone levels may be part of a broader test known as urinalysis.

You can perform a ketonuria test at home, or provide a urine sample at a doctor’s office or diagnostics lab for testing.

Taking the ketone test at home involves following the test instructions. The test typically includes a test strip, or indicator. You place the strip in your urine stream or dip it into a urine sample in a cup. The strip changes color in response to how acidic your urine is.

Your test result may indicate a specific ketone amount, or a grade such as “small,” “moderate,” or “large,” according to the National Library of Medicine.

Talk with your doctor about what ketone levels are healthy for you. This can vary depending on factors such as your diet and physical activity.

When to check your ketones

You may already measure your ketones if you have diabetes. According to the American Diabetes Association (ADA), many experts advise checking your ketones in the follow cases:

  • If your blood glucose is more than 240 mg/dL, measure every 4–6 hours.
  • If you are ill, such as with a cold or flu, measure every 4–6 hours.
  • Measure your ketones if you have symptoms of ketoacidosis.

Diabetes and ketones

Your body needs insulin to convert glucose into energy. If there is not enough insulin to use, your body starts breaking down fat for energy instead. This process produces ketones. Too many ketones can lead to diabetic ketoacidosis, which is life threatening left untreated.

If you have diabetes, follow your doctor’s guidance for monitoring your insulin and blood glucose levels. This will help ensure your body has what it needs to convert glucose into energy.

Your doctor may also recommend regularly monitoring your ketone levels. Talk with your doctor about addressing increased ketones in your urine.

Learn how insulin helps manage diabetes.

What to do if you have ketones in your urine

If you have diabetes and test your ketone levels at home, contact your physician to discuss your results. If your ketones are high, they can recommend next steps, which may include adjusting your treatment plan.

Contact your physician promptly for elevated ketones and symptoms of ketoacidosis or a high blood sugar value. Seek immediate help by calling 911. Treatment may involve insulin through intravenous injection.

Do not exercise when you have ketones in your urine and your blood glucose is high. When you exercise, your body needs more energy, which can raise ketone levels further.

If ketonuria is the result of diet or fasting, certain lifestyle changes may help resolve the condition. These can include eating more carbohydrates and reducing or stopping fasting.

Prevention of ketonuria

Eating a balanced diet and getting regular, moderate exercise can help prevent excess ketones.

If you have diabetes, it is important to monitor your blood sugar to ensure it stays within levels your doctor recommends. The ADA suggests maintaining the following blood sugar levels:

  • 80–130 mg/dL before a meal
  • less than 180 mg/dL 1–2 hours after beginning the meal

Avoiding excessive alcohol use and fasting also can help prevent excess ketones.

Learn more about healthy blood sugar levels.

Frequently asked questions

Danielle Hildreth, R.N. reviewed the following questions.

Does ketones in your urine mean you are dehydrated?

Ketones in your urine may be a sign of dehydration.

What is the normal range for ketones in urine?

A normal range for ketones in urine depends on several factors, including diet and physical activity. It’s important to talk with your health care professional to determine what a normal range is for you.

Why would a person without diabetes have ketones in their urine?

Ketonuria could be due to a lack of carbohydrates or exercising too much. A high level of alcohol consumption and pregnancy are other possible causes.

Summary

Ketones in your urine occur when your body breaks down fat for energy instead of glucose. This could be due to diet, exercise, or excessive alcohol use. Treatment for ketonuria, or excess ketones, may require lifestyle changes.

Ketonuria can also be a symptom of diabetes. If you have diabetes and monitor your urine at home, ketones in your urine may indicate you need to adjust your treatment.

Contact your healthcare professional if testing shows higher ketone levels than expected. For ketoacidosis, you may require insulin administered intravenously at a hospital.

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Medical Reviewer: Danielle Hildreth, CPT
Last Review Date: 2022 Sep 30
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