All About Ketones in Urine and Ketone Test Strips

Rebekah Kuschmider
Rebekah Kuschmider
March 10, 2023
min read
Technically reviewed by: 
Diagnox Staff
All About Ketones in Urine and Ketone Test Strips

What are ketones?

Ketones are our body's contingency plan to meet energy shortfalls whenever they occur. Our body needs energy which it gets from glucose (sugar) primarily. When blood-glucose levels get low, our liver comes into action and uses the available body stores of fat as a source of energy. In this process, it produces certain acids called ketones or ketone bodies. The ketones are then released into the bloodstream to energize our cells, muscles, and tissues.

Having ketones in the body is generally a normal process. Higher than normal ketone levels in the blood could mean that the body is burning fat for energy due to a lack of available glucose or underlying health conditions such as diabetes. However, the production of too many ketones is dangerous. It could turn our blood too acidic, which can be harmful to the organs. If this happens, our kidneys try to flush them out of the body through our urine. The medical term for high ketone levels in the urine is ketonuria. Dangerously high levels of ketones in urine result in a medical condition called ketoacidosis.

Excess ketones in the body could result in ketoacidosis, requiring clinical intervention.

What does it mean to have ketones in urine?

Ketones in the urine do not normally appear in measurable amounts. They are detected in the urine only when the body/blood has excess ketones. This usually happens in situations such as fasting when the sugar intake reduces significantly for extended periods, with a low-carbohydrate/high-fat diet, after strenuous exercise, during pregnancy, or more seriously in persons with chronic diabetes.

How is ketone in urine related to the health of your organs?

The appearance of small-to-moderate levels of urinary ketones should not be a matter of concern in persons without diabetes. But in diabetic patients, high ketone levels can lead to a life-threatening condition called diabetic ketoacidosis. It can potentially cause severe complications such as kidney damage, stroke, heart attack, diabetic coma, or fluid accumulation in the lungs.

What are the leading causes of ketones in urine?

Ketones in the urine can occur due to a health condition such as diabetes, pregnancy, starvation, or eating disorders. Dietary choices such as a low-carbohydrate/high-protein keto diet and certain lifestyle choices such as fasting, strenuous exercise, and excessive alcohol consumption can also trigger ketonuria. Some of the leading causes for ketone in urine are discussed below:  

Ketones in the urine due to the keto diet

Trace amounts of ketones can appear in the urine if your carbohydrate intake is restricted due to the keto diet. The ketogenic diet is a low-carbohydrate/high-protein diet people take to lose weight. It changes the body's energy consumption and usage pattern. In the absence of enough carbohydrates, our body starts breaking down the available proteins and stored fat to meet its energy requirements. In the process, it makes ketones to fuel the body. Excess ketones are filtered out by the kidneys, which causes ketones in the urine.

Ketones in urine during pregnancy

Gestational diabetes during pregnancy can cause ketones in urine. Gestational diabetes is when your blood sugar level becomes high, and you have other symptoms of diabetes. Gestational diabetes can occur in expecting mothers who didn't have diabetes before their pregnancy. Ketones in urine during pregnancy suggest that you and your baby aren't getting enough energy from your diet, which can be detrimental to your baby's developing brain cells.

Ketones in urine due to diabetes

In diabetic patients, ketone levels become high when the body does not have sufficient insulin to convert sugar into energy or when it fails to utilize the available insulin properly. The body then breaks down fat to get the energy it needs. During this process of converting fats into energy, the liver produces ketones and releases them into the bloodstream. High levels of ketones in the blood accompany high blood sugar levels in diabetic patients. When both blood glucose and ketone levels are abnormally high, it is referred to as diabetic ketoacidosis (DKA), which is a life-threatening condition.

Physical signs and symptoms of diabetic ketoacidosis (DKA):

The onset of diabetic ketoacidosis is usually quick and requires immediate medical attention. While taking blood and urine tests for ketones and glucose are the best way to know if you have DKA, the appearance of the following physical symptoms should also serve as a sign:

  • Dry mouth
  • Irregular heartbeat
  • Shortness of breath
  • Fruity-smelling breath
  • Severe thirst
  • Urinating frequently
  • Dehydration
  • Exhaustion and weakness
  • Confusion

Regular monitoring of urinary ketones can be life-saving in both insulin-dependent (type 1) or diet-induced (type 2) diabetes. If detected, ketonuria or ketones in urine indicate the need to take insulin or other necessary interventions to lower blood sugar. Medical experts recommend people with diabetes should regularly check urine for ketone during illness or if two consecutive tests put the blood sugar level above 250 mg/dL. Urinary ketone monitoring is also warranted if two tests taken four to six hours apart show high blood sugar.

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Ketosis vs Ketoacidosis – What’s the difference?

Although ketosis and ketoacidosis sound very similar, they are two significantly different conditions.

Ketosis (or nutritional ketosis)

Ketosis is a diet-induced condition to support weight loss. By consuming low-carb/high-fat foods, usually combined with fasting, the body starts producing ketones as it breaks down fats for energy. Higher-than-normal levels of ketones in the bloodstream trigger ketosis, which is touted to have several health benefits. Supervised diet-induced ketosis is often referred to as nutritional ketosis, which is a balanced state of ketosis essential for maintaining general well-being and health.

Ketone Levels in Blood Ketone Levels in Urine
Normal <0.5 mmol/L <0.5 mmol/L
Light Nutritional Ketosis 0.5 – 1 mmol/L
0.5 – 1.0 mg/dL
0.5 – 1 mmol/L
(Trace to Small)
Optimum Nutritional Ketosis 1.0 – 3.0 mmol/L
1.0 – 3.0 mg/dL
1 – 3 mmol/L
(Small to Moderate)

Blood and urine ketone levels in nutritional ketosis

Starvation ketosis

Starvation may occur due to various reasons such as swallowing disability, prolonged fasting, or eating disorders like anorexia nervosa. Prolonged eating restrictions/constraints for medical, economic, or self-imposed dietary reasons lead to starvation ketoacidosis (SKA). The SKA manifests itself in extreme weakness, the thinning of the body and bones, and severe loss of strength due to muscle breakdown. Screening for starvation ketoacidosis can be carried out by checking glucose and ketone levels in the blood and urine.


If the ketone levels surge to dangerously high levels, it is referred to as ketoacidosis, which is a life-threatening condition. An unsupervised keto diet, in rare cases, can lead to ketoacidosis in the non-diabetic population.

Diabetic ketoacidosis

Diabetic ketoacidosis, on the other hand, is usually not a metabolic process. It is a diabetes-related complication in which ketone and glucose concentrations in the blood get dangerously high due to a lack of insulin. It usually takes two to three days for the body to transition from ketosis to ketoacidosis. Soon after, the typical effects of DKA may begin.

How to differentiate between nutritional ketosis and diabetic ketoacidosis?

Differentiating between nutritional ketosis and diabetic ketoacidosis is simple. In diabetic ketoacidosis, both ketone and glucose levels in the blood are elevated. Excess amounts in the blood often result in elevated levels of glucose and ketones in the urine as well. Diabetic ketoacidosis also causes acidic pH of the blood. In contrast, nutritional ketosis does not result in elevated blood glucose levels. Since nutritional ketosis is achieved by restricting carbohydrate intake, blood glucose levels are expected to be low. In nutritional ketosis, you may find ketones in urine but should not find glucose in urine.

Why do ketone levels in the keto diet need monitoring?

A keto diet is considered safe as long as too many ketones do not accumulate in your blood. Keto-flu, the body's response to a sudden drop in blood glucose levels, is a typical consequence of a keto diet. It occurs in the early stages of a ketogenic lifestyle and manifests as muscle cramps, fatigue, mood swings, sleeplessness, and constipation. Some remedies can help alleviate these acute symptoms.

It is essential to keep track of your nutritional needs. Nutritional imbalance sometimes occurs, causing problems such as extreme weakness and fatigue, inability to concentrate, mood swings, anemia, and chills, which require prompt attention to avoid any risks or complications, such as those due to ketoacidosis. Any nutrition plan should, therefore, be adopted after consultation with a nutritionist or a healthcare professional.

Ketone buildup in the bloodstream due to nutritional ketosis or fasting can be particularly risky for those with diabetes or other medical conditions involving the kidneys, liver, and gallbladder. Therefore, regular monitoring of blood and/or urine ketone levels is strongly recommended for these at-risk groups.

At-home urine ketone test

A urinalysis test is performed to measure the levels of ketones in the urine. The test can be administered both in clinical and home settings using ketone test strips (dipsticks) which people refer to by different names such as keto strips, keto test strips, and ketosis strips. Multiparameter urine test strips such as Urinox-10 are typically lined with multiple reagent test pads that check for other chemicals besides ketones in the urine. When dipped in the urine, the ketone reagent pad changes color from buff-pink to dark purple. The color of the reagent pad is then compared with the accompanying color key to interpret ketone levels in the urine. The intensity of the reagent pad color increase with the urine ketone concentration. The results of a ketone test are read 30- 40 seconds after dipping it in the urine stream to get accurate results.

Ketonox Ketone Test Strips in resealable packs

Normal and Abnormal Ranges of Ketones in Urine

A ketone-in urine dipstick test yields a negative result if significant quantities of ketones are not detected. A positive result is indicated by five different levels depending on the concentration, from trace to large levels of ketones, as shown below:

  • Trace level: 5 mg/L
  • Small: 15-20 mg/dL
  • Moderate: between 30 and 40 mg/dL
  • Large: 80 to 160 mg/dL
Urine Keto Strips change color from light peach to dark purple based on the concentration of ketones in the urine sample.

A positive result for ketone in urine can mean different things to people with various health goals. For example, trace to moderate levels are targets for people on a keto diet. However, even trace levels of ketone in urine can be alarming for diabetic patients.  

You should consult your healthcare provider if your ketone in urine test shows abnormal values, particularly if you have diabetes or other health conditions.

Drinking more water, avoiding sugary foods and drinks, and desisting from exertion can be handy if expert medical intervention is not readily accessible.

Why are ketones in urine tests important?

The urinary ketone test is one of the most valuable, simplest, and cost-effective ways to detect, manage and monitor diabetes, and to forestall diabetic, alcoholic, or starvation ketoacidosis. The test is also relevant in situations such as nutritional ketosis, fasting, overexertion, or to measure ketones in urine during pregnancy. Any possible accumulation of ketones in the body can be avoided by proactively tracking our metabolic states.

Monitoring of ketone levels is warranted for individuals on a keto diet. It helps them regulate their dietary requirements based on their body's metabolic condition. A urine ketone test allows you to determine if the body is in a healthy (safe) state of ketosis, where a steady production of ketones signifies that your body is using the stored and consumed fat as an energy source.

  1. Ben Harder (2003), "Ketones to the rescue: Fashioning therapies from an adaptation to starvation," 164(24), 376–0.
  2. JHM Staff, “Diabetic emergencies,” John Hopkins Medicine.
  3. NIH Staff, “Eating disorders,” National Library of Medicine. MedlinePlus.
  4. Guthrie, Diana W. (1986). Continue to Test Urine for Ketones. The American Journal of Nursing, 86(5), 533.  
  5. WebMD Staff, “Ketones and their tests,” WebMD.
  6. WebMD Staff, “What is ketosis?” WebMD.
  7. Mundt, A. Lillian, Shanahan, Kristy. Graff's Textbook of Urinalysis and Body Fluids, Third Edition, 2016, 96.
  8. Strasinger, S. K., & Di Lorenzo, M. S. (2014). Chemical examination of urine. Blood. FA Davis, 82.
  9. Gershuni VM, Yan SL, Medici V. Nutritional Ketosis for Weight Management and Reversal of Metabolic Syndrome. Curr Nutr Rep. 2018 Sep;7(3):97-106.
  10. NHS Staff, “Diabetic ketoacidosis,” National Health Service, UK

About the Author
Rebekah Kuschmider

Rebekah has been writing about culture, health, and politics since 2010. She has a masters degree in Arts Policy and Administration from The Ohio State University. Her work has been seen at WebMD, The Candidly, MedicineNet, YourTango, Ravishly, Babble, Scary Mommy, Salon, Role Reboot, The Good Men Project, SheSaid, Huffington Post, and Mamamia. She is a former cohost of the weekly podcast The More Perfect Union. Rebekah lives in Maryland with her husband, two kids, and a dog who sheds a lot.

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This blog was
Technically reviewed by: 
Diagnox Staff

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