Differential Diagnosis: Ketonuria

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.