Blood Ketones
- Also Known As:
- Serum Ketones
- Plasma Ketones
- Beta-hydroxybutyrate
- Ketone Bodies
- Beta-hydroxybutyric Acid
- Acetoacetate
- Acetoacetic Acid
- Acetone

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At a Glance
Why Get Tested?
To determine the amount of ketones (ketone bodies, acetoacetate, beta-hydroxybutyrate, and acetone) in your blood to help diagnose life-threatening problems such as diabetic ketoacidosis (DKA) or alcoholic ketoacidosis (AKA)
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 Testing.com. 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.
Testing.com 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 as 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.
Diabetic ketoacidosis (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. Symptoms may also include 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 prolonged starvation, alcoholism, and with high-fat, low-carbohydrate diets (keto 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.
- Acetoacetate is created first when fat is metabolized.
- Beta-hydroxybutyrate is created from acetoacetate. Beta-hydroxybutyrate is the predominant ketone body present in severe diabetic ketoacidosis (DKA).
- Acetone is a spontaneously created side product of acetoacetate.
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 the bedside in a hospital or emergency room, in a health care practitioner’s office, or performed at home.
Common Questions
View Sources
Sources Used in Current Review
2020 review performed by H. L. Chong, MD, FASN, FRSPH, IPFPH, Physician, MJ Healthcare Group.
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(Updated: October 30, 2015) Devkota B. Ketones. Medscape Reference. Available online at https://emedicine.medscape.com/article/2087982-overview. Accessed March 2020.
(© 2020) Mayo Clinic Laboratories. Beta-Hydroxybutyrate, Serum. Available online at https://www.mayocliniclabs.com/test-catalog/Overview/9251. Accessed March 2020.
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