What are the results of a Diabetic Ketoacidosis (DKA) urine test?

From the Guidelines

A diabetic ketoacidosis (DKA) urine test primarily checks for ketones, which are produced when the body breaks down fat for energy due to insufficient insulin, with results indicating negative, trace, small, moderate, or large amounts of ketones 1. To test for DKA, healthcare providers use urine dipsticks that change color when ketones are present. The test is simple and involves urinating on a test strip or into a cup where a strip is dipped. Results are typically available within minutes, with color changes indicating the level of ketones. While urine ketone testing is useful for screening, it's not as accurate as blood ketone testing since urine results reflect ketone levels from hours earlier, as stated in the guidelines for laboratory analysis in the diagnosis and management of diabetes mellitus 1. For diagnosis of DKA, urine testing is usually combined with blood tests measuring glucose levels, blood ketones, and arterial pH. Some key points to consider when interpreting the results of a DKA urine test include:

• The presence of ketones in the urine may indicate DKA, but it is not a definitive diagnosis on its own 1
• The level of ketones in the urine can provide information about the severity of the condition, with higher levels indicating more severe ketoacidosis 1
• Urine ketone testing should be used in conjunction with other diagnostic tests, such as blood glucose and blood ketone tests, to confirm a diagnosis of DKA 1 Patients with diabetes should consider having ketone test strips at home to check when blood glucose is consistently above 240 mg/dL or during illness, as early detection of ketones can help prevent progression to full DKA. It is essential to note that management goals for DKA include restoration of circulatory volume and tissue perfusion, resolution of hyperglycemia, and correction of electrolyte imbalance and acidosis, and individualization of treatment based on a careful clinical and laboratory assessment is needed 1.

From the Research

Diabetic Ketoacidosis (DKA) Urine Test Results

The results of a DKA urine test typically indicate the presence of ketones in the urine, which is a key criterion for diagnosing DKA 2, 3, 4, 5. The test is usually performed using a urine dipstick, which can detect the presence of ketones such as acetoacetic acid and beta-hydroxybutyric acid.

Key Findings

• A positive urine ketone test result is often used as an indicator of DKA, although it is not always a reliable surrogate for plasma ketones 6.
• The presence of high urinary or blood ketoacids is one of the three criteria required to confirm a diagnosis of DKA, along with elevated blood glucose levels or a family history of diabetes mellitus, and a high anion gap metabolic acidosis 2.
• Urine dipstick testing for ketones is widely used when DKA is suspected in patients with hyperglycemia, but it is essential to note that the test is not always accurate and may require further confirmation using other methods such as plasma beta-hydroxybutyrate (β-OHB) levels 6.

Diagnostic Criteria

• The diagnosis of DKA is typically confirmed when all three of the following criteria are present:
  • Elevated blood glucose levels or a family history of diabetes mellitus
  • The presence of high urinary or blood ketoacids
  • A high anion gap metabolic acidosis 2, 3, 4, 5
• Plasma β-OHB levels >3 mmol/L are diagnostic of DKA, while levels <1 mmol/L are insignificant 6.

Testing Methods

• Urine dipstick testing for ketones is a common method used to detect the presence of ketones in the urine 6.
• Point-of-care blood testing for ketones, such as the hand-held electrochemical ketone monitor, can provide an accurate and precise result and can be used as an alternative to the manual enzymatic method in the diagnosis of DKA 6.