Everything You Need to Know About Ketones in Urine

April 02,2020 |

When you visit a urologist, one of the most common tests performed is a urinalysis. A urinalysis helps your doctor see how well your body is functioning and whether or not everything is working as it’s meant to be. Urine gives insight about your habits, underlying conditions, whether or not you have any infections, and more. Contrary to what you might think, your urine says a lot about you. Therefore, it comes as no surprise that a urinalysis is such a routinely performed test. In certain instances during a urinalysis, your test results may come back with elevated levels of ketones. If this happens, it could be a sign of something more serious. To better understand what this means, we’re going to dive into everything you need to know about ketones in your urine.

What are Ketones?

Ketones are acidic chemicals made in your liver that are produced when you don’t have enough insulin at any given time.2 Everyone has ketones in the urine, but they’re more prevalent in people with chronic conditions like diabetes that inhibit or restrict your body’s ability to produce insulin. When you don’t have enough insulin, your body burns fat as an energy source instead—which is turned into ketones by your liver.2 After ketones have been created, they’re sent into your bloodstream for your muscles and tissues to use as fuel.2

In most people, ketones don’t pose a problem. However, for people with diabetes, an excess of ketones can be life threatening. If you have diabetes, talk to your doctor about your ketone levels to better understand how to manage them.

What is Ketosis?

A lot of people have probably heard about the ketogenic diet. Please keep in mind that this is only safe for people who are not diabetic, and it still needs to be discussed with your doctor. Ketosis is the physiological state that occurs when your body starts to rely on fat-sources for fuel instead of carbohydrates.3 Many people achieve this through a low-carb, high-fat diet, fasting, or even excessive periods of exercise.3 Again, if you’re considering making any changes to your diet or exercise plan, it’s important to talk to your doctor.

Are Ketones Dangerous?

Ketones aren’t dangerous for the average person. However, if you’re diabetic, ketones can be life threatening. To make sure that you stay safe, it’s important to measure your blood glucose levels regularly and go to your doctor for a urinalysis if you’re experiencing any signs or symptoms of excess ketones.

Reasons for Elevated Ketone Levels in Urine

Aside from purposefully raising your ketone levels for ketosis, there are a few other instances where elevated ketone levels are known to occur. The following things can result in high levels of ketones:4

  • Diabetes
  • Pregnancy
  • Eating disorders
  • Strenuous exercise
  • Chronic vomiting or diarrhea
  • Eating a low-carbohydrate diet
  • Pneumonia
  • Alcohol abuse
  • Infection
  • Heart attack
  • Stroke
  • Fasting
  • High fever
  • Sepsis
  • Burns
  • Hyperthyroidism
  • Nursing without proper nutrition

There are many reasons that ketone levels may be elevated in your urine, so working with a healthcare professional to get a urinalysis and a proper diagnosis is crucial.

Why You Should Measure Ketones

The best way to measure ketone levels is through a urinalysis. This is the most accurate way to get a reading on your levels at any given moment. When ketones travel through the bloodstream your kidneys filter out the blood and emit ketones as a waste product in urine. Because of this, a urinalysis will give you similar results as blood tests, without as much effort.

It is important to know that at low concentrations, most ketones are reabsorbed by the kidney and re-circulated throughout the body.3 If you’re diabetic, a blood test is recommended to make sure that there are no excess ketones left in your blood. If you’re not diabetic, a urinalysis will be sufficient to tell if you have a ketone buildup. Anyone can use a urinalysis to test for ketones and there are many options for home testing in case of emergencies or other needs.


If you’re looking to go on a ketogenic diet, success will only occur if you’re in ketosis. Ketosis occurs when your blood’s ketone concentration is above 0.5mmol/L.3 During this time, your body starts to use fat cells for energy instead of carbohydrates, which is attributed to fat loss over time. Ketosis is said to help healthy individuals lose weight from fat while retaining muscle mass. If you’re interested in doing this, measuring your ketones will be an important part of the diet plan. Always discuss your plans with your doctor before starting any ketogenic diet regimen to make sure that you stay healthy and safe.  

Diabetic Ketoacidosis (DKA)

Diabetic ketoacidosis (DKA) is a medical emergency where your body is unable to absorb blood glucose into the muscles or other body tissues for energy.3 This can occur in both diabetic patients and those too far in ketosis. If you start experiencing signs and symptoms of DKA, it’s important to get to a hospital as soon as possible, as it can lead to coma and even death.3 Some signs of DKA include dry mouth, excessive thirst, a racing heart beat, and rapid breathing.3

Symptoms of Ketone Buildup

If you’re experience an unusually high level of ketone buildup, you’re likely going to have symptoms. These symptoms are extremely important to watch out for, especially if you have if you have diabetes, as ketone buildup can cause certain side effects. Some symptoms of ketone buildup include:1

  • Frequent urination
  • Dry mouth
  • Strong thirst or feelings of dehydration
  • Blood sugar levels higher than 240mg/dL

While these are the initial symptoms of ketone build up, they will worsen when left unaddressed. Severe ketone buildup is serious and can lead to dangerous complications. The progression of ketone buildup will eventually lead to the following:1

  • Extreme fatigue
  • Confusion
  • Nausea
  • Flushed skin
  • Fruity smelling breath4
  • Vomiting
  • Stomach pains
  • Difficulty breathing

If you notice any of these signs of elevated ketone levels, seek medical attention immediately. Excessive ketone buildup is dangerous, regardless of if you’re diabetic or not, and needs to be addressed by a medical professional.

If you’re diabetic, your signs and symptoms may be more severe. Keep a close eye on your body and report any changes to your doctor.

How to Test for Ketones

There are three primary ways to test for ketones in your body: through a urinalysis, blood testing, and breath testing. Remember, if you have diabetes, especially type 1 diabetes, testing your urine for ketones should be implemented in your diabetic management plan. Talk to your doctor about a ketones urine test.


The most popular way to test for ketones is through a urinalysis. Using a test strip is one of the more accurate, less invasive ways to test and can be done at home with fairly low marginal error. There are urine test strips for at-home testing available in many places over-the-counter.

Blood Testing

Blood testing for ketones is similar to how diabetics measure their blood glucose levels. You’ll need a specific device, which can be purchased for at-home use. Once you prick your finger and administer a blood sample, your readings will appear on the screen.

Breath Testing

Finally, you can purchase a device that will measure ketones through your breath. While this is the most convenient method, many people prefer more concrete methods like a urinalysis or blood test.

Understanding Your Results

When you undergo a ketone test, it’s important to understand how to read your results.  There can be small abnormalities, moderate abnormalities, and large abnormalities.

Small abnormalities—ketone levels that are about 20mg/dL—are normal if you’re trying to lose weight, maintain healthy blood sugar, and monitor your ketones regularly.3 People with diabetes need to take extra precautions and retest regularly. It’s also recommended to consult your doctor.

Moderate abnormalities are when ketone levels range from 30 too 40mg/dL.4 Large abnormalities are when ketone levels are over 80mg/dL.4 If you express either moderate or large ketone abnormalities, contact a doctor immediately.


If you’re interested in going on a ketogenic diet or need to measure your ketones for diabetes management, it’s important to get a regular urinalysis and monitor any changes at home. If you notice any signs of symptoms of ketone build up, don’t hesitate to call your doctor or get to a hospital. If you need any urological supplies or educational resources, don’t forget to visit our educational support page and our product selection guide. Byram Healthcare is proud to offer full-service urological care and we have all the high quality urological supplies that you need. If you need to order any urological supplies, all of your orders can be discreetly delivered to your home, at any time of the day. If you have any urological questions or need personalized, confidential services, our teams of knowledgeable urological customer service specialists are here to help.