Thanks for the invite. Before answering this question, it is important to first understand what ketone bodies are all about. Ketone bodies are products of fat breakdown, which include acetoacetic acid, beta-hydroxybutyric acid, and acetone. The production of ketone bodies must be accomplished in the mitochondria of liver cells due to the fact that the liver has a powerful enzyme system for synthesizing ketone bodies.

After being produced in the liver, ketone bodies leave the liver cells to enter the bloodstream and travel through the circulation to extrahepatic tissues. Of these, acetone is excreted through the lungs and the other two ketone bodies enter the tricarboxylic acid to supply energy to the cells of the body tissues. It is important to note that the body's energy supply system is divided into two categories, the starch-glucose system and the fatty acid-ketone body system.

Generally speaking, the body itself uses the starch-glucose system preferentially for energy supply, and it is only when this system becomes inefficient that the latter becomes the preferred energy supply system. The so-called inefficiency is naturally divided into two cases, one in which no starchy or sugary foods are taken in, and the other in which, in spite of the fact that starchy or sugary foods are taken in, the body is unable to utilize these sugars and is obliged to activate the fatty acid-ketone body system for energy supply.

Whatever the case, when the fatty acid-ketone body energy supply system is activated, large amounts of ketone bodies are produced. Note: Once produced, ketone bodies are either converted to energy for the tissue cells or excreted in the urine. In the presence of an adequately supplied starch-glucose system, ketone bodies are produced in very small quantities, and urinary ketones are often undetectable at this time. Only when the fatty acid-ketone body energy supply system is fully activated, and the tissue cells are unable to fully utilize the ketone bodies for energy, the natural excess ketone bodies are excreted through the kidneys, which are urinary ketones.

Urinary ketone production can be seen to be associated with the activation of the fatty acid-ketone body supply system. Possible causes include starvation, ketogenic diets and severe diabetic ketoacidosis. The first two tend to have normal or slightly low blood glucose, but ketoacidosis blood glucose can be very high, sometimes so high that it may refer to a situation in which a glucometer is unable to measure it. To emphasize: the easiest way to distinguish between nutritional ketogenic or ketoacidosis is blood sugar.Keto moderate blood sugar must be very high!

Welcome to my headline-Jiangsu Provincial Cancer Hospital Li Feng.

This is a very level-headed question that accurately describes the two reasons why urinary ketones occur: insufficient intake of sugar and intake of sugar but the body's inability to utilize it, which are the two main reasons for the appearance of ketosis.

Glucose is the main energy supplier for the body, and when you are hungry the amount of glucose is not enough to supply energy to the cells. Eat into the food, food is digested into glucose, but due to the lack of insulin, glucose can not enter the cells, for cellular energy supply, is due to diabetes, ketone bodies, ketone body production is too much, the liver can not be completely broken down to utilize, the blood ketone body content is too much, a part of it will be excreted with the urine, ketonuria.

Ketone bodies are products of fat breakdown and include acetoacetic acid, beta-hydroxybutyric acid, and acetone. They are synthesized in the mitochondria of liver cells. After being produced in the liver, ketone bodies enter the bloodstream and reach the cells that need energy supply with blood circulation, and it is mainly acetoacetic acid and β-hydroxybutyric acid that play the role of energy supply.

Another reason for ketonuria is that the amount of carbohydrates in the food eaten is very small or not at all, so that the body's energy supply is also provided by proteins and fats, so that although normal eating, but also ketonuria. This is the "ketogenic diet" that has become so popular in recent years.

The amount of carbohydrates needed by the body to provide the energy required by the body is 50-60% of all calories consumed per day. For an adult, the amount of glucose needed is 100-120g per day, which is why fasting patients need glucose water infusions. Some diabetic patients who are not able to eat also need IV glucose water also to solve the problem of the patient's energy supply.

Understanding the above, want to determine the cause of ketonuria is very easy. Normal eating, if there is ketonuria, to clarify the structure of the diet, if the meal is not reasonable is also the cause of the ketogenic diet, to let the patient understand the importance of a balanced mix of various nutrients, and regular physical examination to observe the effect of the ketogenic diet and side effects. If eating a non-ketogenic diet and eating a very large amount of meals, it is necessary to clarify the patient's glucose, electrolytes, pancreatic islet function and other indicators, to rule out diabetic ketoacidosis and the degree of acidosis. In this case, the patient will usually have the corresponding symptoms, such as thirst, excessive drinking, fatigue,, nausea, vomiting, impaired consciousness and other symptoms, the condition is usually more serious, the progress is more rapid, and the need to be as soon as possible for the infusion of fluids and insulin therapy.

The cause of ketonuria without food is usually easier to determine. Patients may be unable to eat due to prolonged inability to eat, severe vomiting in pregnancy, acute gastroenteritis, fever, malignant fluid, and many other reasons, leading to the appearance of ketonuria. It usually disappears soon after feeding or infusion of glucose solution and treatment of the primary disease, but it should be distinguished from diabetic ketoacidosis.

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