Differential Diagnosis: Ketonuria
Elijah Ernst, DVM, North Carolina State University
Karyn Harrell, DVM, DACVIM (SAIM), North Carolina State University
ArticleLast Updated November 20211 min readPeer Reviewed
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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.