From the Guidelines
Trace ketones in urinalysis with reflex to microscopic testing is a crucial diagnostic tool, particularly for individuals prone to ketosis, such as those with type 1 diabetes, history of diabetic ketoacidosis (DKA), or treated with sodium–glucose cotransporter 2 (SGLT2) inhibitors, as it helps identify mild ketosis and potential metabolic problems 1. When trace ketones are detected, it suggests that the body is burning fat for energy instead of carbohydrates, which can be a normal response to fasting, strenuous exercise, or low-carbohydrate diets, but may also indicate early metabolic issues.
- For healthy individuals with trace ketones, increasing carbohydrate intake to 50-100g daily and ensuring adequate hydration (at least 8 glasses of water daily) is typically sufficient.
- However, diabetic patients should check blood glucose levels and contact their healthcare provider if ketones are present alongside elevated blood sugar (>250 mg/dL), as this may indicate impending or established DKA, a medical emergency 1. The reflex to microscopic examination means the laboratory will automatically examine the urine sample under a microscope if other parameters like blood, protein, or nitrites are abnormal, helping to identify cellular elements, crystals, or bacteria that might indicate infection or kidney issues 1. It is essential to note that individuals prone to ketosis should measure ketones in urine or blood if they have unexplained hyperglycemia or symptoms of ketosis, and implement sick-day rules and/or seek medical advice if urine or blood ketones are increased 1.
From the Research
Urinalysis with Reflex to Microscopic Examination
- Urinalysis is a crucial diagnostic tool for detecting ketones in patients with diabetic ketoacidosis (DKA) 2, 3, 4.
- The presence of ketones in the urine is one of the diagnostic criteria for DKA, along with hyperglycemia and metabolic acidosis 2, 3, 4.
- A reflex to microscopic examination may be necessary to confirm the presence of ketones and to rule out other conditions that may cause similar symptoms 2.
Ketone Detection in Urine
- Ketones can be detected in the urine using dipstick tests or laboratory-based assays 3, 4.
- The sensitivity and specificity of ketone detection in urine vary depending on the method used and the severity of DKA 5.
- Routine surveillance of capillary ketone levels may represent a DKA mitigation strategy and implies a potential threshold for continuous ketone monitoring 5.
Clinical Significance of Ketone Detection
- The detection of ketones in urine is critical for the diagnosis and management of DKA 2, 3, 4.
- Elevated ketone levels are associated with an increased risk of DKA and other complications, such as hyperkalemia and hypokalemia 6.
- The measurement of ketone levels can help guide treatment decisions and monitor the effectiveness of therapy 2, 3, 4.