Ket in urine analysis. Ketone bodies in urine: what is it, pathogenetic mechanisms of occurrence, clinical picture

Ketone bodies (Ketone, KET)

Ketone bodies is a general concept for three metabolic products that are formed in the liver: acetone, acetoacetic And betahydroxybutyric acid.

Fine ketone bodies V general analysis no urine. Although in fact, a small amount of ketone bodies is excreted in the urine per day. Such concentrations cannot be determined by conventional methods used in laboratories, so it is generally accepted that there are normally no ketone bodies in urine.

Ketone bodies are detected in a general urine test when there is a disturbance in the metabolism of carbohydrates and fats, which is accompanied by an increase in the number of ketone bodies in the blood (ketonemia).

IN normal conditions The body draws energy mainly from glucose. Glucose accumulates in the body, primarily in the liver, in the form of a special substance - glycogen. Glycogen forms an energy reserve that can be quickly mobilized if necessary to compensate for a sudden lack of glucose. When there is a deficiency of glucose in the body, glycogen is broken down by enzymes into glucose, which enters the blood.

During physical and emotional stress, during illnesses with elevated temperature and other increased energy costs, glycogen reserves are depleted, the body begins to obtain energy from fat reserves. When fat breaks down, ketone bodies are formed, which are excreted in the urine.

Compared to adults, children have much lower glycogen reserves, begin to use fat earlier, and as a result, ketonuria is detected in urine analysis. In newborns, an increase in ketone bodies in the urine is almost always caused by underfeeding.

If glucose is detected with ketone bodies in a general urine test, then this is sure sign diabetes mellitus

Ketone bodies also appear in a general urine test as a result of dehydration. They are found in the urine during sudden weight loss, feverish conditions, fasting, severe poisoning with severe vomiting and diarrhea.

Ketone bodies (acetone) in urine during pregnancy

Ketone bodies in urine during pregnancy may indicate the presence early toxicosis. This should not be ignored, because ketone bodies poison the body with acetone and can thereby complicate the course of pregnancy.

The level of ketone bodies in urine is expressed in mmol/l or indicated by pluses. The number of pluses determines the level of ketone bodies:

(+) – weakly positive reaction;

(++) and (+++) – positive;

(++++) – sharply positive.

The following ketone bodies are of diagnostic value: acetate, acetone and beta-hydroxybutyrate. They are products of fatty acid metabolism and are synthesized from acetyl-CoA in liver cells.

Normally, ketone bodies are constantly present in biological fluids of the body in negligible quantities (plasma acetone 1-2 mg%), about 20-50 mg are excreted in urine per day. This amount is not detected by conventional samples. If acetone and other ketones are detected in a general urine test, it is important to immediately consult a doctor.

Ketonuria and ketonemia

Ketone bodies provide energy metabolism along with glucose. They are a kind of fuel for myocytes, brain, internal organs(except for the liver, red blood cells) under extreme conditions for the body: hunger, exhaustion, dehydration, severe physical exertion.

When the concentration of fatty acid metabolic products in the blood increases (0.5 mmoll or more), this condition is called ketonemia. It occurs when the formation of ketones is significantly higher compared to their utilization.
Exceeding the normal concentration (more than 0.5-1 mmol/l) is called ketonuria. Acetoacetate and beta-hydroxybutyrate are predominantly excreted in the urine.

Acetone is excreted to a greater extent in exhaled air, and its concentration in urine is the lowest compared to the content of other ketones.

Acetone is a strong poison for cells. A slight excess of the norm provokes the occurrence of pathological symptoms from the respiratory, heart, digestive or nervous systems.

An increase in the amount of urine acetone (acetonuria) is primarily associated with a relative lack of glucose, when the energy demand of cells increases significantly. The result of such fasting is the breakdown of glycogen (glucose reserves), the mobilization of a large amount of fatty acids from the depot.

Interesting! The sweetish smell of acetone on breath appears with ketonemia (more than 10 mg% of acetone in the blood) and ketonuria (detection of ketones in the urine)! Often found in diabetics during decompensation!

2. Ketone bodies in urine

A sharp decrease in the intake of carbohydrates (glucose) into the body’s cells causes a chain of chemical reactions:

1 Breakdown of glycogen in muscles, liver or other tissues, releasing glucose.
2 Glyconogenesis (synthesis of sugar from non-carbohydrate components, for example, from lactic acid).
3 Lipolysis (breakdown of fat to form fatty acids).
4 Metabolism of fatty acids with the formation of ketones in the liver.

Thus, a decrease in blood glucose levels triggers a series of complex reactions aimed at maintaining energy balance cells.

The following are conditions that lead to the accumulation of ketone bodies in the body and their excretion in the urine:

1 Diabetes mellitus type 1 or 2(stage of subcompensation, decompensation, diabetic hyperosmolar coma).
2 Diet with complete or almost complete restriction of carbohydrates, excess fats, proteins, strict fasting, prolonged fasting (exhaustion).
3 Febrile illnesses, flowing with high temperature body or its sharp fluctuations (for example, typhus, malaria). In children, any fever can cause ketones to accumulate in the blood and urine.
4 Infectious diseases(especially acute intestinal infections with diarrhea, vomiting, impaired absorption of carbohydrates).
5 Massive injuries with damage to muscle tissue, crash syndrome, severe operations.
6 Acute alcohol poisoning, isopropyl alcohol, heavy metal salts, organophosphorus compounds, medicines(for example, salicylates).
7 Neoplasms hormone-producing organs (thyroid gland, adrenal glands, pancreas), endocrinopathies (acromegaly, Cushing's disease and syndrome, thyrotoxicosis, cortisol deficiency).
8 Surgeries and brain injuries, subarachnoid hemorrhages.
9 Physiological conditions(any trimester of pregnancy, postpartum period, lactation, newborns up to 28 days). In pregnant women, ketonuria can occur at any week, especially during early stages(at severe toxicosis) and in the third trimester (with preeclampsia, gestational diabetes).
10 with severe overstrain of the muscular system (often in men, athletes).
11 In children, ketonuria can be caused by overwork, uric acid diathesis, infections, poorly selected formula, mental illness and other reasons. A change in diet (refusal of carbohydrates while taking ketogenic foods) in combination with overwork, overexertion, or an acute infectious disease can also cause ketonuria and acetonemic vomiting.
12 Old age (over 70 years old) with many chronic diseases.

3. Main symptoms

At high level ketones in the body, the patient experiences the following symptoms:

1 Asthenia, muscle weakness, decreased performance, attention, reaction speed, drowsiness, lethargy.
2 Thirst, dry mouth, complete absence appetite, aversion to food.
3 Nausea, repeated vomiting.
4 Smell of acetone from the mouth (sweat and urine do not always smell of acetone).
5 Strong headache, abdominal pain.
6 Increased body temperature, dry skin and mucous membranes, bright blush.
7 Increased heart rate.
8 Enlarged liver (temporarily).

Sometimes spontaneous normalization of the level of acetone in the blood occurs, its excretion in the urine ceases, and the patient’s condition improves.

If the severity of symptoms increases (for example, in patients with diabetes, pregnant women), then more menacing signs arise: lethargy, dehydration, toxic damage to the central nervous system, blood acidification (pH shift to the acidic side), disruption of the heart, kidneys, convulsions, coma, death.

Ketoacidosis usually develops suddenly, after exposure to some provoking factor (excess fatty foods, fever, acute stress).

4. Diagnostics

Diagnosis is based on clinical signs, as well as laboratory detection of acetone, beta-hydroxybutyric, and acetoacetic acids in the urine.

At home, you can determine the level of ketones using special test strips with a reagent applied. A color change on the corresponding scale indicates the concentration of ketone bodies.

There are quite a few manufacturers of test strips: Biosensor-AN LLC (Ketogliuk-1, Uriket-1), Abbott, Bioscan, Lachema, Bayer, etc. Their sensitivity is different. Detection of ketones at a concentration of 0-0.5 mmol/l is considered normal.

Table 1 - Comparison of test strip scales from different manufacturers

In addition, glucose or other components of urine can be detected in the same way. Laboratory diagnostics undoubtedly more accurate. Reference values (Invitro) - less than 1 mmol/l. Ketones whose concentration in urine is below this level are not detected during the study.

Important! If a urine test reveals glucose in addition to ketone bodies, then diabetic ketoacidosis should be suspected in a person! This condition requires immediate medical attention!

Additionally, the level of ketones in the blood is diagnosed and biochemical analysis, carry out ultrasonography abdominal organs.

5. Therapeutic measures

Therapy is aimed at relieving symptoms (vomiting, headache, dehydration) and reducing acetone levels. Depending on the severity of the patient’s condition, treatment is carried out at home or in a hospital setting. Sometimes the patient needs to be admitted to the intensive care unit.

1 If a patient is diagnosed with diabetes mellitus, then correction of glucose levels, insulin therapy, and infusion therapy are necessary. After recovery from ketoacidosis, therapy with glucose-lowering drugs is selected, and the patient is told about diet and lifestyle.
2 If there is a temporary disturbance in fat metabolism, a carbohydrate diet is prescribed to restore energy balance.
3 Acute intestinal or other infections are treated with antibacterial, antipyretic drugs with the addition of sorbents, saline solutions(Regidron, Orsol, glucose solution), alkaline drinks ( mineral water) to eliminate dehydration.
4 With alcoholic ketoacidosis, it is important to replenish glucose deficiency, eliminate dehydration, and restore acid-base balance. This is achieved intravenous administration solutions of dextrose and salts (Ringer's, saline, sodium bicarbonate).
5 Sometimes it is enough for a child to replace the milk formula, provide adequate treatment for uric acid diathesis, and eliminate all provoking factors. Over time, ketone bodies will no longer appear in the urine. Great importance It has balanced diet. The diet should be balanced in its main components: proteins, fats, complex and simple carbohydrates, multivitamins, minerals.
6 It is important to note that acetonemic crises in children can be repeated, so to prevent them it is necessary to identify the cause of excessive ketogenesis. This will require additional studies, the list of which is determined by the attending doctor after a conversation and examination.
7 When appearing, especially on later, treatment in a hospital setting, normalization of carbohydrate metabolism and nutrition are indicated. It is important to exclude fatty meats, spicy and smoked foods, broths, butter, lard, mushrooms, cocoa and other ketogenic products. Food should contain easily digestible carbohydrates, vegetables and fruits.

Ketonuria (or acetonuria) is a condition in which ketone bodies are elevated in the urine in adults and children. The production of ketone bodies is the body's response to a deficiency of glucose, intended to provide the body with energy. An increase in ketones in adults can be caused by diabetes, fasting, physical and emotional overload, poisoning, acute infectious diseases, injuries, alcoholism, etc. If ketones are detected, it is urgent to find out the reason for their appearance.

The appearance of ketone bodies in the urine indicates a deficiency of glucose in the body.

What are ketone bodies?

Ketones are byproducts of the breakdown of fatty acids.

The source of energy for tissues and organs is glucogen and glucose, reserves of which are found in small quantities in the liver. But when their level becomes very low, the body begins to use fat reserves. When fat is broken down in the liver, it forms by-products - ketone bodies, which the heart, kidneys, brain and muscles use as additional source energy. Ketones are constantly formed in liver cells, are present in the blood and urine of any adult and consist of the following elements:

weak beta-hydroxybutyric acid - 70%;
the strongest acetoacetic acid (acetoacetate) - 26%;
acetone - 4%.

In practice, the meaning of each individual indicator is not considered, but usually a general, understandable term is used - “acetone”. When talking about acetone in urine, it should be understood that ketones first appear in the blood, but they are detected through urine tests, as the simplest and effective methods research. More often in adults, ketonuria is detected in the urine in poorly controlled or decompensated diabetes mellitus.

To detect the presence of ketones, a urine test must be performed.

Level of ketones in urine

Acetone in a healthy adult accumulates in small doses and is constantly excreted, so ketone bodies should not be present in a general urine test. The ketones contained in the blood are completely eliminated from the body through breathing, through the skin through sweat and urine. If bodies are detected in tests, this means that the functionality of the body is impaired. The presence of ketone bodies is expressed in mmol/l. The content of ketones in urine is shown in the table:

Causes of acetone in urine

The number of ketone bodies increases due to a decrease in circulating insulin and an increase in glucagon.

At the same time, fatty hydrolysis of triglyceride tissue is accelerated (fats are the main source of energy for cells) and the permeability of liver fatty acids through the inner membrane of the mitochondria increases. This entails increased glycogen breakdown, gluconeogenesis, lipolysis, fatty acid oxidation and ketogenesis. These processes are caused not only by uncontrolled diabetes, but also by the following physiological reasons:

acute alcoholism;
severe poisoning with lead, atropine, phosphorus and other chemical compounds;
drug intoxication;
heavy and prolonged physical activity;
improper diet or strict fasting;
complete exhaustion of the body;
severe fever;
infectious intestinal diseases;
tumor in thyroid gland, adrenal glands, etc.

Ketones in urine increase during pregnancy, after childbirth, in early postpartum period, and sometimes during lactation. Elevated ketone levels may also occur in newborns due to a temporary decrease normal level glucose. A positive concentration of ketones in the urine in children and adults is detected with uric acid diathesis, improper feeding, infectious diseases, overwork, nervous exhaustion, etc.

Symptoms

Smell of acetone from the mouth - hallmark symptom the presence of ketone bodies in urine.

Acetonuria is accompanied by the following symptoms:

lack of appetite;
increased fatigue;
apathy;
vomiting or nausea after eating;
dry mouth;
strong thirst;
smell of acetone on breath and when urinating.

Such symptoms mean that if measures are not taken at this stage, the condition will worsen and other, more alarming symptoms will appear:

the liver will enlarge;
the central nervous system will be damaged;
a coma may develop;
excess toxins will lead to poisoning of the body;
The ability to absorb fluid is lost and dehydration occurs.

Diagnosis of ketone bodies in urine

Determination of ketone bodies in urine is carried out independently using special test strips. A strip containing a sensitive reagent is lowered into fresh urine. Positive or negative results are determined by comparing the color scale with the color in which the strip is painted. If test results systematically deviate from the norm, then you need to consult a doctor as soon as possible.
A general urine test will reveal not only traces of ketones in the urine, but will also show changes in the biochemical parameters of urine: protein, leukocytes, mucus, etc. For example, elevated leukocytes indicate infection, and protein indicates physical activity and hypothermia. The analysis will determine the acidic or alkaline environment and the salts contained in the urine: urates, phosphates, oxalates, ammonium urate, etc. In diabetes in an adult, urine usually has an acidic environment.
24-hour urine analysis - more informative diagnostic test excreted urine per day. Methods of collating all the necessary data will help to understand why ketones are elevated and what triggered the increase.

The primary diagnosis of ketone bodies in urine can be done independently using rapid tests.

If sugar is found with ketone bodies, then most likely diabetic acidosis, precoma or coma develops, depending on the symptoms present. If only acetone is found in the urine, without sugar, then the cause is not diabetes. The appearance of acetone in adults is caused by:

acidosis due to fasting, in which sugar burning decreased and fat increased;
a ketogenic diet rich in fat, protein and carbohydrates;
vomiting and diarrhea caused by gastrointestinal disorders;
toxicosis;
poisoning;
high temperature.

It develops due to disorders of carbohydrate metabolism and requires close attention, because it can cause the development of ketoacidotic coma. In this article we will introduce you to the causes of ketoacidosis, its symptoms and treatment principles.

Ketones (or ketone bodies) in urine are a group of organic substances synthesized in the liver during the breakdown of fats and the release of glucose. They consist of acetone, β-hydroxybutyric and acetoneacetic acid.

Normally, these compounds are quickly broken down, and a small part of them is excreted through the kidneys. There are so few of them in urine that they are not even detected during a routine analysis.

When the presence of ketones in urine is not dangerous

Ketones in the urine of diabetics may appear due to non-compliance with a low-carbohydrate diet. If against this background the patient’s blood level does not rise to 13 mmol/l or higher, then such test results are not a reason to prescribe treatment.

Why does ketoacidosis develop?

Diabetic ketoacidosis is a consequence of carbohydrate metabolism disorders. Carbohydrates entering the patient's body cannot be broken down into sugar bases, and insulin deficiency leads to the fact that cells are unable to absorb glucose as an energy source. As a result, the body uses reserves from fat reserves and intensively processes them. Because of this, fats and proteins are not completely oxidized and form acetones, which accumulate in the blood and then appear in the urine.

Ketones in the urine in the first type of diabetes appear when the level of glucose in the blood increases to 13.5-16.7 mmol/l or when glucosuria is more than 3%. With absence timely treatment ketoacidosis can provoke the development of ketoacidotic coma.

As a rule, ketoacidosis in diabetes mellitus is a consequence of late diagnosis or the result of improper treatment:

insufficient insulin administration;
refusal to administer insulin;
accidental missed injections;
infrequent monitoring of blood glucose levels;
incorrect adjustment of the insulin dose depending on the glucometer readings;
the emergence of an additional need for insulin due to the intake of large amounts of carbohydrate-rich foods or the development of an infectious disease;
administering insulin that was improperly stored or expired;
malfunction of the insulin pump or insulin pen.

The following conditions can contribute to the development of ketoacidosis in diabetes of any type:

or inflammatory processes;
injuries;
pregnancy;
taking insulin antagonists: glucocorticosteroids, diuretics, sex hormones;
surgical operations;
taking drugs that reduce tissue sensitivity to insulin: antipsychotics, etc.;
depletion of insulin secretion in decompensated type 2 diabetes.

Sometimes the development of ketoacidosis is caused by doctors’ mistakes:

untimely administration of insulin for type 2 diabetes;
untimely diagnosis of type 1 diabetes.

How to detect the presence of ketones in urine

The following methods can be used to detect ketones in urine:

urine analysis in the laboratory - the results are determined as “+” (+ - a weakly positive reaction indicating the presence of traces of ketones, ++ or +++ - a positive reaction indicating the presence of ketones in the urine, ++++ - a strongly positive reaction indicating the presence of a large number of ketones in the urine);
test strips - the test is dipped into urine for a few seconds, and the results are interpreted by comparing the color on the strip and on the scale attached to the package.

At home, in the absence of test strips, you can find out about the presence of ketones in urine using ammonia. A drop of it must be added to the urine. Its coloration in a bright scarlet color will indicate the presence of acetone.

Symptoms

In most cases, diabetic ketoacidosis develops over several days, and sometimes within 24 hours.

Initially, the patient begins to be bothered by symptoms indicating an increase in blood sugar levels and a lack of insulin:

pronounced thirst;
frequent urge to urinate;
weakness;
unjustified weight loss;
dry skin and mucous membranes.

If left untreated, acidosis increases and ketosis develops:

smell of acetone from the mouth;
vomiting and nausea;
Kussmaul breathing (deep and noisy).

The aggravation of this condition causes disorders of the nervous system:

lethargy and lethargy;
irritability;
drowsiness;
precoma and ketoacidotic coma.

Treatment

The condition of patients with ketoacidosis can be severe.

Treatment of ketoacidosis should begin at the first signs, the presence of which is indicated by the results of blood and urine tests.

A patient with diabetic ketoacidosis initial stage(while maintaining consciousness and the absence of severe concomitant pathologies) they are hospitalized in the department of therapy or endocrinology. And patients in more serious condition are sent to the intensive care unit.

To draw up the correct treatment plan, the department constantly monitors vital signs.

The treatment plan includes the following activities:

insulin therapy;
elimination of dehydration;
elimination of acidosis;
replenishment of lost electrolytes;
treatment of diseases that cause complicated diabetes.

Which doctor should I contact?

Patients with diabetes mellitus You should be constantly monitored by an endocrinologist, take the necessary medications and carry out all recommended tests. If you suspect the development of ketoacidosis, you should immediately consult a doctor or call an ambulance.

The reasons for the appearance of ketone bodies in human urine, as a rule, occur against the background of fasting or diabetes mellitus. If there is a deficiency of phosphorus compounds in the human brain or heart, the body begins to produce ketone bodies. They act as an excellent supplier of energy, better than fatty acids.

Ketones in urine are a result of what is formed in the liver. As a rule, they appear after six days of fasting. In people they persist for different periods of time.

If you have diabetes mellitus, then ketones in the urine appear intermittently. This means that diabetes is characterized by disturbances in energy metabolism; this provokes the body to produce ketone bodies as reserve “fuel”, and their norm is exceeded. Bodies are not a symptom of a disease or its cause.

Concentration of ketone bodies in urine

Ketone bodies are intermediate products formed in the liver. These include:

acetone
acetoacetic acid
beta-hydroxybutyric acid.

Ketone bodies are formed during the process of releasing energy during the breakdown of fats. Very often, in the body of an adult or child, these bodies undergo transformations. But if fat metabolism is greatly exceeded, then bodies are created faster than they are destroyed, which leads to the fact that their rate increases.

As a result, the concentration of bodies in the blood increases significantly and they enter the urine, which leads to ketonuria.

Under the influence of these conditions, the cells of the human body suffer from a lack of the main source of energy. This means that there is a lack of glucose, which accumulates in the liver as glycogen.

After the body has used up all the glycogen, it begins to take energy from fats. Fats are actively broken down, and as a result, the concentration of ketone bodies in the urine increases.

The child may be found to have many conditions associated with energy expenditure. Most often this occurs when:

severe emotional disorders

This is due to the fact that the child’s body does not have significant glycogen reserves. And what we have is wasted at a rapid rate.

As a result of these processes children's body actively consumes fats and ketone bodies appear in the urine.

Doctors may talk about feeding deficiencies or deficiencies if a large number of ketone bodies in a newborn baby.

During pregnancy, ketone bodies occur due to early toxicosis. They are performing alarming symptom, since the body is poisoned by acetone, which will complicate bearing a child.
Please note that ketoacidosis is the most dangerous condition, provoked by an excess of ketone bodies in the urine.
Ketoacidosis is often found in people with diabetes due to a lack of insulin, so before that, it is worth taking care of the issue of ketoacidosis. The consequences may be as follows:

Cardiac arrhythmia;
Respiratory disorders;
Disorders of consciousness;
Brain swelling;
Stopping breathing;
Death.

If ketone bodies are detected in a person with diabetes, you should immediately consult a doctor to remove them.

Ketone bodies in urine in childhood

Most often, ketonuria in a child is a consequence of lipid metabolism disorders or a manifestation of improper absorption of carbohydrates, after which the ketone norm is violated. If ketones are excreted excessively in the urine, the following symptoms may occur:

spasmodic pain in the abdomen;
headache;
general lethargy and fatigue;
vomiting and nausea;
hyperthermia up to 39°C;
decreased appetite;
drowsiness;
smell of acetone from the mouth;
liver enlargement.

This condition in children most often has the following causes:

Overwork
Long trips
Strong emotions
Prolonged stress.

Ketones increase in childhood on the background poor nutrition or colds. A condition such as ketonuria is recorded in children infancy as a consequence of malnutrition.

The causes of acetone syndrome can occur with:

intestinal infections
brain tumors
diabetes mellitus
liver damage
thyrotoxicosis

The syndrome is usually accompanied by uncontrolled vomiting, which leads to dehydration, so timely correction is required.

Detection of ketone bodies in urine

Detection of ketone bodies in urine occurs only with the help of a special urine test, which reveals what the norm of the bodies is. Ketonuria is detected in the laboratory by several methods:

Lange breakdown;
Legal breakdown;
rapid tests;
Lestrade's breakdown;
modified Rothera test.

Express tests in this case mean the use of test strips or special test tablets.

To determine ketone bodies in urine, you should immerse the test strip in the urine, which is the liquid being tested. At positive reaction, the strip will quickly turn purple.

Intensity purple directly depends on the amount of ketone bodies, and if the norm is exceeded, the test will show this. This quantity is determined using a color standard scale.

A drop of urine is applied to the test tablet, after which, depending on the presence of ketone bodies, the tablet changes its color and ketonuria appears.

Treatment of ketone bodies in urine

Ketonuria is an excess volume of ketone bodies when they are actually elevated in the urine. It must be treated along with the reasons that provoked this condition.

Urinary dysfunction requires treatment constant monitoring doctor First of all, you need to undergo a full examination, only then can ketonuria be established.

The success of treatment directly depends on the diagnosis and identification of the specific cause that caused the excess of ketone bodies in the urine.