II. Mechanism

  1. Dipstick detects acetic acid (acetoacetate)
    1. In Diabetic Ketoacidosis, Beta-Hydroxybutyrate (primary ketone) is converted to Acetoacetate
  2. Confirmatory Test
    1. Urine
      1. Acetest tablet test
    2. Blood (preferred)
      1. Beta-hydroxybutyrate
        1. Best ketone test
      2. Basic chemistry panel
        1. Ketoacidosis
          1. Low serum bicarbonate
          2. Increased Anion Gap
        2. Normal or resolving ketoacidosis
          1. Normal serum bicarbonate
          2. Normal Anion Gap

III. Interpretation: Normal

  1. Negative

IV. Causes: Positive

  1. Dehydration
  2. Starvation or Low Carbohydrate Diets
  3. Diabetic Ketoacidosis (DKA)
  4. Alcoholic ketoacidosis
  5. Isopropanol toxicity
  6. Pregnancy

V. Causes: False positive ketones on Urinalysis

VI. Causes: False negative ketones on Urinalysis

  1. Delayed urine exam

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