First off, what are ketones? Ketones are by-products of fat and muscle metabolism. This occurs when the body does not have enough glucose stores, which are converted from carbohydrates to use as cellular energy. When these levels are depleted, or the body is unable to use what glucose stores are available, sources are then derived from fat and muscle cells and subsequently used for energy with the intention of keeping cellular functions working at adequate levels. As a result, the byproducts of fat and muscle cell breakdown, ketones, then circulate in the body through the blood, are excreted by the kidneys, and finally exit the body via urination. Ketones are very acidic and high levels could be toxic and may lead to various health problems associated with a medical condition called ketoacidosis.
How diet and exercise are associated with Ketones in Urine
There are certain conditions in which ketosis, the breakdown of fats and muscle, are actually desired.
• Weight Loss
• High protein and low carbohydrate diets
The most desired result of diet and exercise plans is to loose weight. Many such plans restrict certain foods or at least restrict total caloric intake when compared to energy expenditure. If the body can not get enough glucose from the food consumption, or burns what stores are available from increased exercise, it will start to breakdown fat and muscle cells to provide enough energy for essential functions. The result is then weight loss. While ketones in urine may be detected, they will not be at extreme levels, which could contribute to the long-term harm associated with ketoacidosis.
If there are significant amounts of ketones in urine, there is a high probability that you could be diagnosed with ketoacidosis, an acute medical condition that requires immediate medical treatment. High levels of ketones in urine would indicate that blood pH levels are also likely to be acidic. When the body’s pH level changes from neutral and acidic levels, it destabilizes normal functions creating a toxic environment. To balance this, the pancreases amps up insulin production to clear glucose, which is the intended result of fat and muscles breakdown. A higher level of glucose also leads to acidification of the blood, thereby contributing to the toxicity of ketoacidosis. There are two types of ketoacidosis which will result in significant levels of ketones in urine:
• Diabetic Ketoacidosis
• Alcoholic Ketoacidosis
Diabetic Ketoacidosis (DKA)
Ketones in urine are often associated with a potentially life-threatening complication related to diabetes, in particular those with insulin dependent type 1 diabetes; though people with type 2, non-insulin dependent diabetes, may also become prone to DKA. In DKA, there is not enough insulin in the body to transport glucose and therefore the body starts to break down significant fat and muscle cells as a response. This results in glucose and ketones to spill into the urine at high rates, acidifying the body, creating a toxic environment. Those who are insulin dependent need to monitor blood glucose levels diligently and follow the recommendations for insulin dosing which would minimize the level of ketones in urine, as poorly controlled diabetes can lead to death and serious complications.
Symptoms of DKA include:
• High blood levels of glucose
• High levels of ketones in urine
• Nausea and vomiting
• Excessive urination
• Prominent thirst and dehydration
• Abdominal pain
• In severe cases, a life-threating respiration pattern of deep, gaping breaths called Kussmauls breathing (which is an unconscious attempt by the body to breath off the high levels of acid)
Treatments may include:
• Monitoring intake and output levels
• Intravenous therapy to rehydrate
• Intravenous insulin therapy
Alcoholic Ketoacidosis, (AKA)
Similar to DKA, AKA also produces high levels of ketones in urine. However, unlike DKA, AKA is the result of large consumption of alcohol daily alongside malnutrition resulting from a lack of food and adequate nutrients. Symptoms are similar to those of DKA without the presence of hyperglycemia, high levels of glucose, which are also detected in the blood and urine.
Treatments may include:
• Intravenous therapy of dextrose and other fluids to rehydrate and provide a surge of glucose for insulin to transport, thereby breaking the cycle of ketone production
• Intravenous therapy of vitamins and nutrients
• Treatment of alcohol withdrawal
Testing for Ketones in Urine
Often, those who had never been diagnosed with diabetes will present to physicians with signs and symptoms indicative of DKA; the high presence of ketones in urine may be the first available diagnostic used to diagnose the disease. Besides a blood test, which needs to be sent to a lab for analysis, physicians or other health care providers can complete an in-office dip-stick test to determine a range of ketone levels which may be present in the urine.
Individuals who are diagnosed with diabetes and dependent on insulin are advised to routinely test for ketones in urine, particularly if they have been unwell, unable to eat, or under high levels of stress; any event which would cause hyperglycemic episodes.
Urine dip-stick analysis test strips can be purchased at many pharmacies and health stores. The case comes with predetermined colored ranges, which can help individuals determine the approximate levels of ketones in urine. Anyone who is diabetic, or on an extreme weight loss program could benefit from using the test strips to as an adjunct to monitoring their health.