From the Guidelines
If urine shows ketones, the next step is to check blood glucose levels immediately and increase fluid intake, preferably water or sugar-free fluids. For diabetic individuals, follow your sick-day management plan, which typically involves taking insulin as prescribed even if you're not eating, checking blood glucose more frequently (every 2-4 hours), and testing for ketones regularly 1. Contact your healthcare provider promptly if ketones are moderate to high, especially if accompanied by symptoms like nausea, vomiting, abdominal pain, or confusion, as this could indicate diabetic ketoacidosis (DKA), which requires urgent medical attention. For those with type 1 diabetes, you may need additional rapid-acting insulin according to your healthcare provider's instructions. Non-diabetic individuals showing ketones should increase carbohydrate intake if following a very low-carb diet, or seek medical advice if experiencing unexplained symptoms. Ketones appear in urine when the body burns fat for energy instead of glucose, which can happen during fasting, intense exercise, low-carbohydrate diets, or when diabetes is poorly controlled and insulin is insufficient to process glucose properly 1. It's essential to note that the presence of ketones in urine can be an indicator of impending or established DKA, a medical emergency, especially in individuals with known diabetes mellitus or in previously undiagnosed individuals presenting with hyperglycemia 1. Therefore, it's crucial to take immediate action and seek medical advice if ketones are present in the urine, especially if accompanied by other symptoms. The measurement of β-hydroxybutyrate in blood is recommended for the diagnosis of DKA and may be used for monitoring during treatment of DKA 1. In contrast, blood ketone determinations that rely on the nitroprusside reaction should not be used to monitor treatment of DKA 1. By following these steps and seeking medical attention when necessary, individuals can help prevent complications and ensure proper management of their condition. Key considerations include:
- Checking blood glucose levels immediately
- Increasing fluid intake
- Following a sick-day management plan for diabetic individuals
- Contacting a healthcare provider promptly if ketones are moderate to high or if symptoms are present
- Seeking medical advice for non-diabetic individuals with unexplained symptoms.
From the FDA Drug Label
Hyperglycemia (too much glucose in the blood) may develop if your body has too little insulin ... In patients with type 1 or insulin-dependent diabetes, prolonged hyperglycemia can result in DKA (a life-threatening emergency) ... The first symptoms of DKA usually come on gradually, over a period of hours or days, and include ... fruity odor on the breath. With DKA, blood and urine tests show large amounts of glucose and ketones.
If urine shows ketones, it may indicate Diabetic Ketoacidosis (DKA), a life-threatening emergency. The next step is to obtain medical assistance immediately 2.
From the Research
Next Steps if Urine Shows Ketones
If urine shows ketones, it may indicate diabetic ketoacidosis (DKA), a serious complication of diabetes that requires prompt medical attention. The next steps are:
- Evaluate the patient's symptoms, medical history, and laboratory results to confirm the diagnosis of DKA 3, 4, 5, 6.
- Measure serum glucose, electrolytes, pH, and serum ketones to assess the severity of DKA 4, 5, 6.
- Check for underlying causes of DKA, such as infection, insulin omission, or other medical conditions 3, 4, 5, 6.
- Initiate treatment with intravenous fluids and insulin to correct metabolic abnormalities and manage symptoms 3, 4, 5, 6.
- Monitor glucose and electrolyte levels closely to adjust therapy and prevent complications 4, 5, 6.
- Educate patients on how to manage their diabetes, recognize early symptoms of DKA, and prevent recurrence 4, 5, 6.
Laboratory Tests
Additional laboratory tests may be ordered to evaluate the patient's condition, including:
- Complete blood count with differential
- Blood urea nitrogen and creatinine
- Electrolyte panel
- Urinalysis
- A1C
- Electrocardiography
- Amylase and lipase levels
- Hepatic transaminase levels
- Troponin and creatine kinase
- Blood and urine cultures
- Chest radiography 4, 5.
Ketone Measurement
Ketone measurement can be helpful in diagnosing and managing DKA. Point-of-care tests are available for self-testing of blood ketones and urine ketones 7. However, it is essential to note that urine ketone tests may lag behind blood ketone levels, and beta-hydroxybutyrate is the predominant ketone in blood during DKA 7.