Question

What could be the possible causes or factors for elevated ketones in a child’s urine if they have a fever, sore throat, and pain during urination?

Answer

Elevated ketones in urine may be caused by the following factors:

  1. Diabetic ketoacidosis: This occurs due to reduced glucose utilization, leading to increased fat breakdown and the production of excessive ketones. This condition is often related to uncontrolled or inadequately treated diabetes and can lead to acidosis or coma. Urine ketone tests are crucial for diagnosis but should be differentiated from hypoglycemia, cardiovascular disease, lactic acidosis, or hyperglycemic hyperosmolar diabetic coma. In cases of acute complications in diabetics, urine ketones may decrease or disappear due to kidney function damage.
  2. Non-diabetic ketosis: This includes infectious diseases such as pneumonia, scarlet fever, sepsis, and tuberculosis. Severe diarrhea, vomiting, hunger, prolonged fasting, and post-anesthesia states can also lead to ketone production. Pregnant women may also develop ketonuria due to pregnancy reactions, vomiting, and reduced diet.
  3. Poisoning: Conditions such as chloroform and ether anesthesia, phosphorus poisoning, etc., may also trigger ketonuria.
  4. Use of biguanide hypoglycemic drugs: Such as metformin, which can cause blood sugar to drop but may also result in ketonuria. Urine ketone qualitative tests are often associated with diabetes, pregnancy, malnutrition, and chronic diseases. The results of urine ketones are typically indicated by “plus signs,” while instrumental measurements are semi-quantitative.