Also Known As
Serum Ketones
Plasma Ketones
Beta-hydroxybutyrate
Ketone Bodies
Beta-hydroxybutyric Acid
Acetoacetate
Acetoacetic Acid
Acetone
This article was last reviewed on
This article waslast modified on November 15, 2019.
At a Glance
Why Get Tested?

To determine the amount of ketones (ketone bodies, acetoacetate, beta-hydroxybutyrate, and acetone) in the blood to help diagnose a life-threatening problem called diabetic ketoacidosis

When To Get Tested?

When you have symptoms associated with ketoacidosis, such as increased urination, excessive thirst, dehydration, rapid breathing, and shortness of breath

Sample Required?

A blood sample drawn from a vein in your arm or from a fingerstick

Test Preparation Needed?

None

You may be able to find your test results on your laboratory's website or patient portal. However, you are currently at Lab Tests Online. You may have been directed here by your lab's website in order to provide you with background information about the test(s) you had performed. You will need to return to your lab's website or portal, or contact your healthcare practitioner in order to obtain your test results.

Lab Tests Online is an award-winning patient education website offering information on laboratory tests. The content on the site, which has been reviewed by laboratory scientists and other medical professionals, provides general explanations of what results might mean for each test listed on the site, such as what a high or low value might suggest to your healthcare practitioner about your health or medical condition.

The reference ranges for your tests can be found on your laboratory report. They are typically found to the right of your results.

If you do not have your lab report, consult your healthcare provider or the laboratory that performed the test(s) to obtain the reference range.

Laboratory test results are not meaningful by themselves. Their meaning comes from comparison to reference ranges. Reference ranges are the values expected for a healthy person. They are sometimes called "normal" values. By comparing your test results with reference values, you and your healthcare provider can see if any of your test results fall outside the range of expected values. Values that are outside expected ranges can provide clues to help identify possible conditions or diseases.

While accuracy of laboratory testing has significantly evolved over the past few decades, some lab-to-lab variability can occur due to differences in testing equipment, chemical reagents, and techniques. This is a reason why so few reference ranges are provided on this site. It is important to know that you must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."

For more information, please read the article Reference Ranges and What They Mean.

What is being tested?

Ketones or ketone bodies are byproducts of fat metabolism. This test measures the amount of ketones in the blood.

Ketones are produced when glucose is not available to the body's cells as an energy source and/or when the body cannot use glucose as a fuel source because there is no insulin or not enough insulin. Fat is used for fuel instead. When fat is metabolized, byproducts called ketone bodies build up in the blood, causing first ketosis and then progressing to ketoacidosis, a form of metabolic acidosis. This condition is most frequently seen with uncontrolled type 1 diabetes and can be a medical emergency.

There are three ketone bodies – acetoacetate, beta-hydroxybutyrate, and acetone. Acetoacetate is created first. Beta-hydroxybutyrate is created from acetoacetate. Acetone is a spontaneously created side product of acetoacetate. Beta-hydroxybutyrate is the predominant ketone body present in severe diabetic ketoacidosis (DKA). Different ketone tests measure one or more ketone bodies, and their results are not interchangeable.

Blood testing gives a snapshot of the status of ketone accumulation at the time that the sample was collected. Urine ketone testing reflects recent rather than current blood ketones. Urine testing is much more common than blood ketones testing. It may be performed by itself, with a urine glucose test, or as part of a urinalysis. The urine methods measure either acetoacetate or acetoacetate and acetone but do not usually detect beta-hydroxybutyrate.

Blood ketones may be measured in a laboratory or with a handheld monitor. The laboratory test uses serum, the liquid portion of the blood, and typically measures acetoacetate. Beta-hydroxybutyrate can be ordered as a separate blood test.

When whole blood from a fingerstick is tested for ketones using a handheld monitor, the monitor measures beta-hydroxybutyrate. This test may be performed at a person's bedside in a hospital or emergency room, in a doctor's office, or performed by a person at home.

How is the sample collected for testing?

A blood sample is obtained by inserting a needle into a vein in the arm or by pricking a finger.

Is any test preparation needed to ensure the quality of the sample?

No test preparation is needed.

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Common Questions
  • How is it used?

    Blood ketones are primarily used to screen for, detect, and monitor a serious, sometimes life-threatening condition called diabetic ketoacidosis (DKA) in people with type 1 and sometimes type 2 diabetes. DKA can occur when a diabetic's blood glucose is significantly increased, with illness, severe infection, pregnancy, and a variety of other conditions.

    DKA is associated with sudden and severe high blood glucose (acute hyperglycemia), a severe insulin deficiency, and a disruption of the body's acid-base balance. Excess ketones and glucose are dumped into the urine by the kidneys in an effort to flush them from the body. This causes increased urination, thirst, dehydration, and a loss of electrolytes. The affected person may also experience symptoms such as rapid breathing, shortness of breath, a fruity scent to the breath, nausea, vomiting, fatigue, confusion, and eventually coma.

    Ketosis and ketoacidosis may also be seen with starvation, alcoholism, and with high-fat, low-carbohydrate diets. It may be induced on purpose in some children with epilepsy who have frequent seizures and do not respond to available medications or other treatments.

    There are three ketone bodies: acetoacetate, beta-hydroxybutyrate, and acetone. Beta-hydroxybutyrate is the predominant ketone body present in severe diabetic ketoacidosis. Different ketone tests measure one or more ketone bodies, and their results are not interchangeable. (See the "What is being tested?" section for more.)

    Blood ketones are sometimes ordered, along with other tests such as blood gases, glucose, and electrolytes, to detect ketoacidosis in non-diabetics if they have signs and symptoms of DKA due to, for example, ingestion of excessive amounts of alcohol.

  • When is it ordered?

    Blood ketone tests may be ordered when someone with diabetes has symptoms associated with diabetic ketoacidosis (DKA) and may also be performed whenever there is the potential for DKA to develop, such as when a diabetic is sick or pregnant. With the availability of home monitoring, blood ketones can be ordered as frequently as the person's healthcare provider recommends. Some signs and symptoms of ketoacidosis include:

    • Increased urination, excessive thirst
    • Dehydration, loss of electrolytes
    • Rapid breathing, shortness of breath
    • Fruity scent to the breath
    • Nausea, vomiting
    • Fatigue
    • Confusion
    • Coma (sometimes)

    In non-diabetics, blood ketones are usually ordered when a person has symptoms associated with ketosis or ketoacidosis.

  • What does the test result mean?

    If blood ketone levels are increased, then the person has some degree of ketosis or ketoacidosis.

    If levels are low or normal, then the person either does not have excess ketone production or the ketone body that is elevated is not being detected by the test method used.

  • Is there anything else I should know?

    Recent studies have shown that serum ketones and beta-hydroxybutyrate testing are both effective in diagnosing diabetic ketoacidosis (DKA). Some healthcare practitioners prefer beta-hydroxybutyrate. In acute DKA, the ketone body ratio (beta-hydroxybutyrate:acetoacetate) rises from normal (1:1) to as high as 10:1. In response to insulin therapy, beta-hydroxybutyrate levels commonly decrease long before acetoacetate levels. However, beta-hydroxybutyrate is not available in all laboratories.

  • If I am diabetic, can I just test for glucose instead of ketones? 

    They are related but not the same thing. While increases in ketones are associated with high glucose concentrations, they can also occur with moderate glucose levels in many conditions, such as when you are sick.

  • Can I test for ketones in my urine instead of my blood? 

    In many cases, yes, urine is tested much more frequently than blood. However, since it will not detect beta-hydroxybutyrate, the main ketone body with diabetic ketoacidosis (DKA), your healthcare provider may prefer that you monitor your blood.

  • Can I get diabetic ketoacidosis if I have type 2 diabetes? 

    Yes, although it is not as common as in type 1 diabetes. It may occur in type 2 diabetes, especially when you have a severe infection or illness. Ketosis and ketoacidosis may also be seen in non-diabetics, people with starvation, alcoholism, and with high-fat, low-carbohydrate diets. It may be induced on purpose in some children with epilepsy who have frequent seizures and do not respond to available medications or other treatments.

  • Can I have ketosis or ketoacidosis and not know it? 

    You could have some degree of ketosis with few symptoms, but the accumulation of ketones triggers the symptoms, so they would emerge as concentrations increase.

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Related Content

On This Site

Tests: Urine Ketones (see Urinalysis - The Chemical Exam); Blood Gases; Glucose Tests

Conditions: Diabetes, Acidosis and Alkalosis, Epilepsy

Elsewhere On The Web

American Diabetes Association: DKA (Ketoacidosis) & Ketones
MedlinePlus Medical Encyclopedia: Diabetic detoacidosis
Mayo Clinic: Diabetic detoacidosis

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View Sources

Sources Used in Current Review

2016 review performed by Hui Li, PhD, DABCC, FACB, FCACB, Clinical Chemist, Dynacare.

(Aug. 21, 2015) Mayo Clinic Staff. Diabetic ketoacidosis. Mayoclinic.org [On-line information]. Available online at http://www.mayoclinic.org/diseases-conditions/diabetic-ketoacidosis/basics/definition/con-20026470. Accessed June 2016.

(May 2011) Sacks D. Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus. Clin Chem. Available online at http://www.ncbi.nlm.nih.gov/pubmed/21617152. Accessed June 2016.

(Apr 2011) Stojanovic V. Role of beta-hydroxybutyric acid in diabetic ketoacidosis: A review. Can Vet J. Available online at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3058661/. Accessed June 2016

(Dec, 1999) Laffel L. Ketone bodies: a review of physiology, pathophysiology and application of monitoring to diabetes. Diabetes Metab Res Rev. Available online at http://www.ncbi.nlm.nih.gov/pubmed/10634967. Accessed June 2016.

Sources Used in Previous Reviews

Pagana, Kathleen D. & Pagana, Timothy J. (© 2007). Mosby's Diagnostic and Laboratory Test Reference 8th Edition: Mosby, Inc., Saint Louis, MO. Pp 972-973.

Hurd, R. (Updated 2007 October 31). Serum ketones. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003498.htm. Accessed February 2009.

Holt, E. (Updated 2008 June 17). Diabetic Ketoacidosis MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/000320.htm. Accessed February 2009.

Mayo Clinic Staff (2008 February 9). Diabetic ketoacidosis. MayoClinic.com [On-line information]. Available online at http://www.mayoclinic.com/print/diabetic-ketoacidosis/DS00674/DSECTION=all&METHOD=print. Accessed February 2009.

Hamdy, O. (Updated 2008 July 14). Diabetic Ketoacidosis eMedicine [On-line information]. Available online at http://emedicine.medscape.com/article/118361-overview. Accessed February 2009.

Trachtenbarg, D. (2005 May 1). Diabetic Ketoacidosis. American Family Physician [On-line information]. Available online at http://www.aafp.org/afp/20050501/1705.html. Accessed February 2009.

Sheikh-Ali, M. et. al. (2008 January). Can Serum _-Hydroxybutyrate Be Used to Diagnose Diabetic Ketoacidosis? Diabetes Care 31:643-647, 2008 [On-line information]. Available online at http://care.diabetesjournals.org/cgi/content/full/31/4/643. Accessed February 2009.

Rose, K. and Collins, K. (2008 December 1). Vitreous Postmortem Chemical Analysis. CAP NewsPath [On-line information]. Available online through http://www.cap.org. Accessed February 2009.

(Updated 2008 December 30). Siezures and Epilepsy, Hope Through Research. NINDS [On-line information]. Available online at http://www.ninds.nih.gov/disorders/epilepsy/detail_epilepsy.htm. Accessed February 2009.

Rho, J. (Updated 2009 February 19). The Ketogenic Diet in Pediatric Epilepsy. The Charlie Foundation [On-line information]. Available online at http://www.charliefoundation.org/frames/diet/overview.php. Accessed February 2009.

(2006 July). Answering your questions, Serum acetone testing. [On-line information]. PDF available for download at http://www.mlo-online.com/articles/0706/0706tips%20.pdf. Accessed February 2009.

(Modified 2008 August 11). Ketone Testing. Children’s Physician Network [On-line information]. Available online at http://www.cpnonline.org/CRS/CRS/pa_ketone_pep.htm. Accessed February 2009.

Wallace, T. and Matthews, D. (2004). Recent advances in the monitoring and management of diabetic ketoacidosis. QJM 2004 97(12):773-780. Available online at http://qjmed.oxfordjournals.org/cgi/content/full/97/12/773. Accessed February 2009.

Vorvick, L. (Updated 2011 February 1). Serum ketones test. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003498.htm. Accessed December 2012.

Devkota, B. (Updated 2012 October 11). Ketone (Acetone). Medscape Reference [On-line information]. Available online at http://emedicine.medscape.com/article/2087982-overview. Accessed December 2012.

Raghavan, V. et. al. (Updated 2012 January 3). Diabetic Ketoacidosis. Medscape Reference [On-line information]. Available online at http://emedicine.medscape.com/article/118361-overview. Accessed December 2012.

Clarke, W., Editor (© 2011). Contemporary Practice in Clinical Chemistry 2nd Edition: AACC Press, Washington, DC. Pp 404.

McPherson, R. and Pincus, M. (© 2011). Henry's Clinical Diagnosis and Management by Laboratory Methods 22nd Edition: Elsevier Saunders, Philadelphia, PA. Pg 218.

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