Expert Advice -- Ketones in the Urine?

My three-year-old son went for his well-check, and the pediatrician found ketones in his urine sample. She said that it was probably because he didn't eat. He has been a very picky eater, and will skip meals regularly, but he does eat at least one or two very nutritious meals each day. The little bit of research I have done about ketones mentions diabetes and starvation as possible issues, but also mentions something about a growth hormone. Can you tell me anything about ketones and why they might be showing up in his urine?

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Robert Steele

Robert W. Steele, MD, is a board certified pediatrician at St. John's Regional Health Center in Springfield, MO. He graduated from medical... Read more

The body is able to use several sources of energy in order to allow it to perform its daily duties. However, it prefers to use one particular type of energy source --glucose. The body converts food into glucose and then uses it to allow our muscles to move, our bones to grow and our minds to think. Some glucose is stored, but not a whole lot because storing glucose is not a very efficient use of space. Therefore, there are other ways the body can store energy, and that is in the form of fat -- as any adult with a New Year's resolution list will tell you. When the body runs low on glucose, it begins to use the fat stores for energy.

Now here is where it gets a bit complicated. Glucose is very efficient source of energy. It's waste products are simply carbon dioxide (which is breathed out) and water. Fat, on the other hand, does not burn so cleanly. In the process of metabolizing fat for energy, some of the by-products are ketones. The body has glucose available from the food that was just recently eaten as well as some stored in certain organs. However, most of this can get used up within several hours, depending upon the activity of the person. Then, the fat begins to get used. It is metabolized and some ketones are produced which are then excreted in the urine.

It is normal for people to produce some ketones in between meals, particularly if it has been a while since the last meal. A small amount of ketones found in a routine urine specimen is a very typical finding in someone who hasn't eaten in a few hours.

You are right that ketones do have particular significance in children with diabetes and other diseases, but in an otherwise healthy child, a small amount of ketones in the urine is usually normal. And these ketones go away with the next meal since it allows for a renewed source of glucose. It sounds like this is what your pediatrician meant when analyzing his urine results, but you should confirm this with her.

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