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Related Experiment Videos

Follow-up testing for ketonuria. Is it necessary?

H M Abdelaziz1, H H Billett

  • 1Department of Pathology, Long Island Jewish Medical Center, New Hyde Park, NY 11042.

American Journal of Clinical Pathology
|March 1, 1994
PubMed
Summary

Confirming trace urinary ketones with Acetest is necessary when using Multistix. Higher ketonuria levels detected by Multistix do not require further testing or microscopic evaluation, saving costs.

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Area of Science:

  • Clinical Chemistry
  • Urinalysis
  • Diagnostic Accuracy

Background:

  • Urinary ketones are indicators of metabolic status.
  • Multistix and Acetest are common dipstick tests for ketonuria.
  • The clinical utility of trace ketonuria requires clarification.

Purpose of the Study:

  • To evaluate the confirmation utility of Acetest for Multistix-detected ketonuria.
  • To assess if ketonuria warrants microscopic urine examination.
  • To determine the cost-effectiveness of confirmatory testing.

Main Methods:

  • Tested 4345 urine samples with Multistix for ketones.
  • Retested 108 positive samples with Acetest.
  • Prospectively assessed sensitivity and specificity on 179 samples using both methods.

Main Results:

  • Multistix showed 98% positive predictive value for small amounts or more of ketonuria.
  • Multistix had 96% specificity, but sensitivity dropped to 63.6% when trace ketonuria was considered positive.
  • Ketonuria did not significantly increase the likelihood of positive microscopic findings.

Conclusions:

  • Acetest confirmation is only needed for trace ketonuria detected by Multistix.
  • Confirmatory testing for higher ketonuria levels offers minimal clinical benefit and increases costs.
  • Ketonuria alone is not an indicator for microscopic urine evaluation.

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