Understanding High Ketone Levels and What They Mean
High ketone levels can indicate various metabolic states, from a normal response to a ketogenic diet to a severe condition like ketoacidosis. Ketones are produced by the liver when the body uses fat for energy instead of glucose.
Nutritional Ketosis vs. Diabetic Ketoacidosis (DKA)
- Nutritional Ketosis: This is expected on a ketogenic diet as the body burns fat. While ketone levels are elevated, they are typically safe. However, very high levels with illness symptoms may signal an issue.
- Diabetic Ketoacidosis (DKA): A life-threatening complication primarily for people with type 1 diabetes, but also possible in type 2. Insufficient insulin leads to high blood sugar and excessive ketone production.
Other factors causing high ketones include prolonged fasting, heavy alcohol use, and extended illness.
The Role of Hydration in Managing High Ketones
Increasing fluid intake is a key initial step for managing high ketones, helping to excrete them through urine. Aim for about 8 ounces of fluid every 30 to 60 minutes.
What to Drink When Blood Sugar is High (for Diabetics)
If you have diabetes and high blood sugar (e.g., above 250 mg/dL or 14.0 mmol/L), choose sugar-free drinks.
- Water: The primary source of hydration.
- Sugar-free electrolyte drinks: These help replace lost minerals like sodium and potassium, especially with frequent urination or vomiting. Ensure they contain no added sugar or carbs.
- Broth: Provides sodium to help restore electrolytes and can be comforting.
What to Drink When Blood Sugar is Normal or Low (for Diabetics)
If ketones are high but blood sugar is normal or low (sometimes called "starvation ketones"), carbohydrate-containing fluids may be needed to provide glucose and prevent hypoglycemia.
- Regular fruit juice: A small amount offers quick carbs.
- Sugary soft drinks: Can help raise low blood sugar.
- Sports drinks with sugar: Like regular Gatorade, they provide fluids and carbohydrates.
Beverage Comparison for Managing High Ketones
| Type of Drink | Best for... | Consideration | Examples |
|---|---|---|---|
| Plain Water | General hydration, high blood sugar | Excellent flushing agent, no carbs or sugar | Tap water, bottled water |
| Sugar-Free Electrolyte Drink | High ketones with high blood sugar, replacing lost minerals | Replenishes vital electrolytes, avoid added sugars | Water with drops, low-carb powders |
| Bone Broth | High ketones with high blood sugar, illness, electrolyte replacement | Restores sodium, comforting when sick | Beef, chicken, or vegetable broth |
| Regular Juice or Soda | High ketones with low/normal blood sugar (starvation ketones) | Provides carbohydrates to prevent hypoglycemia | Apple juice, orange juice, regular soft drinks |
| Herbal Tea (Unsweetened) | Simple hydration, high blood sugar | Calming and hydrating, choose sugar-free options | Chamomile, peppermint tea |
The Importance of Electrolytes
High ketones, especially when accompanied by illness, can lead to the loss of essential electrolytes like sodium and potassium through increased urination and vomiting. Replacing these is crucial. While water hydrates, it doesn't replenish electrolytes. Therefore, sugar-free electrolyte drinks or broth are often recommended alongside water.
When to Seek Medical Attention for High Ketones
While nutritional ketosis is usually safe, high ketones with certain symptoms, particularly for individuals with diabetes, may indicate DKA, a medical emergency. Seek immediate medical care if you experience:
- Consistent blood sugar over 300 mg/dL (16.7 mmol/L).
- Moderate or large ketones in blood or urine.
- Persistent nausea and vomiting.
- Extreme thirst or frequent urination.
- Rapid or labored breathing.
- Fruity-smelling breath.
- Fatigue or weakness.
- Confusion.
Conclusion
If you have high ketones, prioritize increasing fluid intake to help your body eliminate them. For those with diabetes, the best drink choice depends on your blood sugar: sugar-free options for high blood sugar and carbohydrate-containing fluids for normal or low blood sugar. Replacing lost electrolytes with sugar-free drinks or broth is also important. Consistently monitor blood sugar and ketones and get immediate medical help if DKA symptoms appear. For more on Diabetic Ketoacidosis, consult the CDC.
