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Differential Diagnosis: Ketonuria

Elijah Ernst, DVM, North Carolina State University

Karyn Harrell, DVM, DACVIM, North Carolina State University

Endocrinology & Metabolic Diseases

|November/December 2021|Peer Reviewed

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Differential Diagnosis: Ketonuria

Following are differential diagnoses for patients presented with ketonuria.*

  • Spurious (eg, urine containing compounds with sulfhydryl groups [captopril, valproic acid, D-penicillamine, tiopronin, cystine], urine containing phthalein dyes, highly pigmented urine, urine containing aspirin)
  • Diabetic ketoacidosis
  • Fanconi syndrome
  • Hyperosmolar hyperglycemia (ketonuria is usually mild with this disorder)
  • Gestational insulin resistance 
  • Starvation, malnutrition
  • Low-carbohydrate diet
  • Glycogen storage disease
  • Organic acidemia
  • Hypoglycemia in young patients (particularly toy breeds)
*Urine dipsticks detect acetoacetate (primary) and acetone (to a lesser degree); they will not detect beta hydroxybutyrate.

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For global readers, a calculator to convert laboratory values, dosages, and other measurements to SI units can be found here.

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