The testing of urine for the presence of ketonuria is an essential part of diabetes monitoring. Ketone acids include acetoacetic acid anda beta hydroxybutyric acid. Acetoacetic acid spontaneously degrades to form a molecule of acetone and carbon dioxide. The currently available clinical tests only measure acetoacetic acid,yet the levels of beta-hydroxy butyric acid are usually four times that of acetoacetic acid. During hypoxia, severe shock or when there is lactic acidosis, this ratio may be greatly increased and a measure of the acetoacetic acid level may greatly underestimate the actual total level of ketone acids.

Urine should be tested for ketones in the following circumstances:

  • If vomiting occurs.
  • Any time the blood glucose is above 15 mmol/L ,especially if the child or adolescent is unwell and especially if the blood glucose has been high for more than 24 hours
  • If unusually drowsiness is present.
  • In the presence of high temperature, vomiting or diarrhoea, even when the blood glucose is 15 mmol/L.
  • In abdominal pain occur.
  • If breathing is rapid and suggestive of ketoacidosis
  • If the child or adolescent has flushed checks

Ketonuria is the presence of hyperglycaemia is in indicative of severe insulin deficiency and calls for urgent therapy to prevent progression into ketoacidosis. Ketonuria in the prense of low blood glucose levels is indicative of a starvation state or is the result of a counter-regulatory response to hypoglycaemia. (dr. rendra)


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