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Ketonuria Information and Courses from MediaLab, Inc.

These are the MediaLab courses that cover Ketonuria and links to relevant pages within the course.

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Laboratories Individuals

Chemical Screening of Urine by Reagent Strip
Clinical Significance of Positive Urine Ketone Result

Ketone bodies are usually absent in urine. High levels of ketones are present in the urine of individuals with uncontrolled diabetes. In diabetes the ketones are present because the body's ability to metabolize carbohydrates is defective. Detecting the presence of ketones in the urine is a valuable aid to managing and monitoring individuals with diabetes mellitus. Ketonuria is an indication that the insulin dose needs to be increased. It is also an early indicator of insulin dosage problems in juvenile diabetes or in diabetics experiencing other medical problems. Electrolyte imbalance and dehydration occur when ketones accumulate in the blood. If these conditions are not corrected, the patient may develop acidosis and ultimately diabetic coma. Low levels may be detected during conditions of physiological stress such as fasting, rapid weight loss, frequent strenuous exercise or prolonged vomiting. The presence of ketones in these situations is due to either inadequate intake or increased loss of carbohydrates.

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Confirmatory and Secondary Urinalysis Screening Tests
Causes of Ketonuria

Under conditions of abnormal carbohydrate metabolism such as occurs in diabetes mellitus, ketones accumulate in the blood (ketonemia) and are excreted in the urine (ketonuria). The accumulation of ketone bodies is often the cause of acidosis and coma in diabetics.

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Detection of Ketone Bodies

“Ketone bodies” is a generic term which refers to acetoacetic acid (diacetic acid), acetone, and beta-hydroxybutyric acid. Screening procedures used to detect ketonuria do not react with all ketone bodies. Since all three of the ketone bodies will be present in the urine and are equally significant, it is sufficient to detect an increase in any one or two of the ketone bodies. Most procedures, including Acetest®, measures acetoacetic acid and acetone but not beta-hydroxybutyric acid.

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Correlation of Urine Glucose and Ketones

It is important to test for urinary (and plasma or serum) ketones when any patient shows a greater than normal excretion of sugar or reducing substances. Screening for ketonuria is useful in following the effects of treatment for diabetes and in judging the severity of acidosis. Large amounts of ketones will appear in the urine before serum ketone levels are elevated.

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Other Causes of Ketonuria

Ketonuria can also be found in conditions associated with a decreased intake of carbohydrates (starvation), digestive disturbances, dietary imbalance (high fat/low carbohydrate diet), eclampsia, prolonged vomiting and diarrhea, glycogen storage diseases, vigorous exercise, fever, and following administration of anesthesia. Ketone bodies are mildly toxic to the body, tending to interfere with the excretion of uric acid, produce mild depression of the central nervous system, and cause acidosis.

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