My 5 year old son had strep pharyngitis 2 weeks ago and was treated with keflex x 10days. Midway through the keflex course he c/o lower bilateral abdominal pain although he would first point to the right lower quadrant. Yesterday he developed a fever, headache, sore throat, and abdominal pain. No N&V, no diarrhea, no one else is sick in the house. He was seen by his PCP who did a throat culture, UA and culture. His UA showed +4 ketones, trace blood, +1 protein, negative glucose, and specific gravity of 1.010. We were given a second course of Keflex and sent to the ED where they did another UA, CBC, and CMP. Glucose 116. UA still had +4 ketones but no other abnormalities. Today he is febrile 101 to 102 F, with abdominal pain which is lower bilateral but a little more on the right side. The ED said that he could have an appendicitis brewing and to keep an eye on him. The also said that his urine did not look dehydrated and his electrolytes looked normal so they are not sure why his ketones are so high. Any thoughts?