Ketonuria with no glucose

Re: Ketonuria with no glucose

Neil Wheadon — Fri, 29 Nov 2013 22:48:13 GMT

A trick to see if the result is false is to put plasma on the test strip and see if it reacts. In one study in cats urine strips were more sensitive in detecting ketones in plasma rather than the urine Neil

Re: Ketonuria with no glucose

karen jones — Fri, 29 Nov 2013 18:33:58 GMT

Thank you, we have checked ketones with the farm animal ketones meter and he had ketones in blood and urine. We are going to have him back in next week and do more bloods . He looks remarkably well , fed on royal canin senior and is used as a pat dog. He came in with increased urination . Will keep you undated.

Re: Ketonuria with no glucose

Rory Bell — Fri, 29 Nov 2013 18:16:10 GMT

sorry - should have added. Beware interpreting bile acids in a hyperbilirubinemic dog; mechanical obstruction to bile flow will induce increases in bile acid concentrations even in normally functioning livers as both substances are excreted in the biliary system. Ammonia might be a more reliable indicator of liver dysfunction, but in any case, as Martin said, dysfunction would be unlikely in this case.

Re: Ketonuria with no glucose

Rory Bell — Fri, 29 Nov 2013 18:12:58 GMT

Hi Karen

In addition to what Andy and Martin have said, non diabetic causes of ketonuria would include:

False positive (ketonuria indicated on striptest but no ketones actually present) might be seen in pigmented urine and in acidic urine as well as in animals given Vitamin C

True ketonuria (without diabetes) might be seen in dogs fed high fat and/or low carbohydrate diets, persistent fever, persistent hypoglycaemia or dehydration

I'm not sure if any of those possibilities apply to your case. Perhaps worth looking at recent diet (it is a Lab after all!). Its also true that severe illness might induce a catabolic state sufficient to produce ketonemia / ketonuria, but I think this is unlikely as your patient appears quite well.

a true ketonuria should be accompanied by ketonemia. It might, if this ketonuria is repeatable and none of the Ddx above apply, by worthwhile measuring beta hydroxybutyrate concentrations in the bloodstream. Its one of three ketones produced by dogs; the other two (acetone and acetoacetate) are detectavle on urine dipstix while B-OHbutyrate is not, this test will confirm ketone production and possibly avoid some of the false positive causes of ketonuria described above.

Hope this helps

cheers

rory

Re: Ketonuria with no glucose

Martin Atkinson — Fri, 29 Nov 2013 12:24:19 GMT

Ketones are produced when the Krebs cycle is not functioning properly due to intracellular hypoglycaemia typically in DKA. This dog has some evidence of liver disease so this may be the cause although I guess the liver enzymes would be expected to be raised but it is probably worth doing bile acids and CK. I have an incredibly sensitive nose for ketones and if they were genuinely present in the urine due to ketosis I would smell it on the breath, not everyone has this gift so may not be a practical suggestion.

Re: Ketonuria with no glucose

Andrew Kent — Thu, 28 Nov 2013 22:28:25 GMT

You can get ketone production with starvation but that seems unlikely. There are a few things which cause false positives of ketones on dipstick, off the top of my head very pigmented urine, acidic urine, some drugs can all give positive reaction.

Andy