Symptoms of Ketones in Urine

It’s normal to have a small number of ketones, which are compounds made by the liver, in your urine. However, when ketone levels are high, also known as ketonuria, it may mean something more serious is going on.

Normally, your body burns sugar for energy. But, there are times when the body may need to use another energy source, like fat, instead. This may occur with fasting or diabetes, a group of conditions where there is too much sugar in the blood. When fat is used as an energy source, ketones are made as a waste product. If ketone levels get too high, they can become toxic to the body.

This article explains the signs and symptoms of ketones in urine. It will also discuss what conditions can trigger ketonuria, possible complications, as well as when to reach out to your doctor.

Symptoms of Ketones in Urine - Illustration by Katie Kerpel

Verywell / Katie Kerpel

What Are Symptoms of Ketones in Urine?

Symptoms of ketonuria are only experienced when ketone levels are high, particularly above 0.6 mmol/L.

Symptoms of ketonuria include:

If you have any of these symptoms and there is suspicion of diabetes or another condition, a healthcare professional may suggest checking your ketones with a blood or urine test.

What Conditions Cause Ketones in Urine?

Symptoms of ketonuria more commonly show up in people with diabetes. With diabetes, individuals don’t make enough of the hormone insulin or their body doesn’t use it properly. Insulin helps your body process and store sugar for energy use. So, if you have ketones in your urine, it could mean that you aren't getting enough insulin.

Even if you do not have diabetes, you can develop symptoms of ketonuria. This can happen with:

  • Long term vomiting or diarrhea
  • Extreme exercise
  • Restrictive diets
  • Eating disorders, which are a group of mental health conditions that involve a hyper-focus on food, eating, body image, and/or exercise
  • Alcohol use disorder, which describes being unable to stop using alcohol despite it causing social, work-related, and health issues
  • Pregnancy
  • Infection

Recap

Many conditions can lead to symptoms of ketonuria including infection, diabetes, pregnancy, stomach issues, as well as other disorders.

What Are Complications of Ketonuria?

If you have uncontrolled diabetes, or are in the midst of long-term fasting or restrictive dieting, ketone levels can skyrocket. High ketone levels cause acid to build up in the blood. This is toxic to the body and can be life threatening. In those with diabetes, this is referred to as diabetic ketoacidosis.

Complications associated with ketoacidosis include:

  • Cerebral edema, which refers to a medical emergency when the brain swells and doesn't get enough oxygen
  • Cardiac arrest, which is when the heart stops beating
  • Kidney failure, which is when the organs that filter waste from the blood stop working properly
  • Coma, which is a condition where an individual is unconscious for a long period
  • Death

When Should I See a Healthcare Professional for Ketonuria?

Whether or not you have diabetes, if you are experiencing signs of ketonuria, contact a healthcare professional right away. Your provider may order a test to check for ketones.

In the meantime, you should increase your water intake and check your blood sugar to make sure your levels are under control. 

Keep in mind that if you suspect you have diabetic ketoacidosis, you should seek medical attention immediately. This is considered an emergency.

Recap

Contact your doctor if you have any signs of ketonuria. If you have diabetic ketoacidosis, seek emergency medical care right away.

Summary

Having some ketones in your urine is normal, however high amounts, also known as ketonuria, may signal an underlying issue. Symptoms of ketonuria may include fruity-smelling breath, feeling very thirsty, and needing to pee often.

Ketonuria may be caused by conditions including long-term vomiting and diarrhea, diabetes, infection, pregnancy, eating disorders, and alcohol use disorder. Ketonuria can lead to life threatening complications, so it's important to reach out to your doctor right away if you show any signs of this.

Frequently Asked Questions

  • Are ketones bad?

    It depends. In people with diabetes, the presence of ketones often indicates a problem, such as diabetic ketoacidosis. High levels may also indicate other conditions in those who don't have diabetes, such as pregnancy, restrictive dieting, or an infection.

  • What are the symptoms of diabetic ketoacidosis?

    Symptoms of diabetic ketoacidosis include: 

    • Feeling less alert
    • Rapid breathing
    • Dehydration
    • Dry mouth and skin
    • Frequent urination
    • Fruity-smelling breath
    • Headaches 
    • Muscle stiffness
    • Vomiting and stomach pain
  • Can dehydration cause ketones in urine?

    Not typically. Ketones show up when the body burns fat for energy. Starvation can cause high amounts of ketones, but dehydration does not.

6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Luethi N, Cioccari L, Crisman M, Bellomo R, Eastwood GM, Mårtensson J. Prevalence of ketosis, ketonuria, and ketoacidosis during liberal glycemic control in critically ill patients with diabetes: an observational study. Crit Care. 2016;20:297. doi:10.1186/s13054-016-1462-7

  2. MedlinePlus. Ketones in urine.

  3. Li J, Wang X, Chen J, Zuo X, Zhang H, Deng A. COVID-19 infection may cause ketosis and ketoacidosisDiabetes Obes Metab. 2020;22(10):1935-1941. doi:10.1111/dom.14057 

  4. MedlinePlus. Acidosis.

  5. MedlinePlus. Diabetic ketoacidosis.

  6. American Diabetes Association Professional Practice Committee. 6. Glycemic targets: Standards of medical care in diabetes—2022Diabetes Care. 2022;45(Supplement_1):S83-S96. doi:10.2337/dc22-S006