Is Ketones In Urine Bad

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Are Blood Ketones A Better Predictor Than Urine Ketones Of Acid Base Balance In Diabetic Ketoacidosis?

Abstract Detection of ketonaemia is a key factor in diagnosing diabetic ketoacidosis (DKA). Measurement of urinary ketones via the nitroprusside reaction is the most commonly employed diagnostic test; however, near patient testing of blood ketones is now widely available. In the clinical setting we wished to compare the utility of urine and blood ketone measurements to predict acid base balance and need for admission in patients with type 1 diabetes. A retrospective study was performed on 52 patients referred to the metabolic or acute receiving units of a teaching hospital. Urine and capillary ketone measurements, blood gas analysis and/or venous bicarbonate measurement were analysed together with the clinical outcome of either admission or discharge of the patient. Capillary β-hydroxybutyrate measurement gave a strong negative correlation (r -0.771; p<0.001) with serum bicarbonate concentration. Urine ketone measurement showed a weaker negative correlation (r -0.493; p<0.001) with bicarbonate levels. There was no difference in the ability to predict hospital admission between blood ketone measurement and urine ketone measurement )positive predictive value 84.6% [95% confidence in Continue reading >>

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Popular Questions

  1. Johanna

    I have found various sources saying that ketones are acidic (pKa=20), and then relate it to the formation of the enolate ion. However, isn't an enolate ion of a ketone basic due to the oxygen's negative charge and all the pairs of electrons surrounding it?

  2. bon

    I think you need to recall the definition of an acid (in the Bronsted-Lowry scheme). An acid is a proton donor. A base is a proton acceptor. When a acid dissociates, it forms a hydrogen ion and the conjugate base of the acid. Remember, acid and base are only relative terms. The species which loses a proton in the reaction is acting as an acid and that which gains a proton is a base.
    In the example above, the ketone is acting as an acid because it donates a proton. The hydride anion is acting a base because it accepts a proton. The resulting enolate anion is stabilised by delocalisation of the negative charge onto the oxygen. In the reverse reaction, the enolate would act as a base, accepting a proton from hydrogen (this is unlikely to happen though because the hydrogen will be liberated as a gas).

  3. DraggyWolf

    It will shift the places of the double bond and one of the hydrogen atoms, which will end up in a compound with a double bond between two of the carbon atoms.
    That makes an enol which isn't as stable as a Ketone. The enol and Ketone are in a equilibrium which causes the enol to lose an hydrogen ion which then - the enol will become an enolate.

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