A blood sample is needed.

No preparation is needed.

When the needle is inserted to draw blood, some people feel slight pain. Others feel a prick or stinging. Afterward, there may be some throbbing or a slight bruise. This soon goes away.

Ketones are substances produced in the liver when fat cells break down in the blood. This test is used to diagnose ketoacidosis. This is a life-threatening problem that affects people who:

• Have diabetes (diabetic ketoacidosis or DKA). It occurs when the body cannot use sugar (glucose) as a fuel source because there is not enough insulin. Fat is used for fuel instead. When fat breaks down, waste products called ketones build up in the body.
• Drink large amounts of alcohol (alcoholic ketoacidosis).

A normal test result is negative. This means there are no ketones in the blood.

Normal value ranges may vary slightly among different laboratories. Some labs use different measurements or test different samples. Talk to your health care provider about the meaning of your specific test results.

A test result is positive if ketones are found in the blood. This may indicate:

• Alcoholic ketoacidosis
• Diabetic ketoacidosis
• Starvation
• Uncontrolled blood glucose in people with diabetes

Other reasons ketones are found in the blood include:

• A diet low in carbohydrates can increase ketones (sometimes called a ketogenic diet).
• After receiving anesthesia for surgery
• Glycogen storage disease (condition in which the body can't break down glycogen, a form of sugar that is stored in the liver and muscles)

There is little risk in having your blood taken. Veins and arteries vary in size from one person to another and from one side of the body to the other. Drawing blood from some people may be more difficult than from others.

Other risks associated with having blood drawn are slight, but may include:

• Excessive bleeding
• Fainting or feeling lightheaded
• Multiple punctures to locate veins
• Hematoma (blood accumulating under the skin)
• Infection (a slight risk any time the skin is broken)

Acetone bodies; Ketones - serum; Nitroprusside test; Ketone bodies - serum; Ketones - blood; Ketoacidosis - ketones blood test; Diabetes - ketones test; Acidosis - ketones test

Crandall JP, Shamoon H. Diabetes mellitus. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 216.

Mojica A, Weinstock RS. Carbohydrates. In: McPherson RA, Pincus MR, eds. Henry's Clinical Diagnosis and Management by Laboratory Methods. 24th ed. Philadelphia, PA: Elsevier; 2022:chap 17.

Updated by: Jacob Berman, MD, MPH, Clinical Assistant Professor of Medicine, Division of General Internal Medicine, University of Washington School of Medicine, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.