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Pregnant having ketones in urine. Will it harm the mother and baby?

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General & Family Physician
Practicing since : 1978
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My wife is 6 week pregnant (First pregnancy) . We did pregnancy screening yesterday which includes CBC, TSH, FBS, Urine, HIV, VDRL, HBsAg, HPLC and Rubella IgM, IgG. We got the lab report today. I could see all the reports are within Normal range except below:
URINE Examination - Ketones (7 mg/dl), Leucocyte Esterase - Positive, Epithelial Cells +++ (IN LARGE NUMBERS)
Rubella Antibody Panel - Rubella IgG - 131 iu/mL
Can you please advise me the interpretation of it, Is there any risk to my wife and unborn baby. I would appreciate your response.

Many Thanks
Posted Fri, 1 Jun 2012 in Pregnancy
Answered by Dr. Pavan Kumar Gupta 55 minutes later
Hello and thanks for the query.
 occasional traces of ketone bodies in urine during pregnancy do not seem to be a very serious problem, unless there are larger amounts or frequent bouts of ketones in urine. 

Though it is always recommended to consult a doctor for this problem, in order to prevent ketones in general, you should avoid skipping meals or having long gaps between each meal and should eat after every 3 to 4 hours during pregnancy. Also, try having a good bedtime snack which should be XXXXXXX in proteins and starch. This is because protein slows down the absorption of carbohydrates which benefits by making energy available to the body for a longer duration of time. Also, remember not to keep more than 9 to 10 hours between your bedtime snack and breakfast as this will lower the risks of having ketones. Hence, consider having small frequent meals high in proteins and starch in order to avoid ketone in urine during pregnancy.
Leukocyte esterase (LE) is a urine test for the presence of white blood cells and other abnormalities associated with infection.
White blood cells in the urine usually indicate a results are clinically significant. The combination of the LE test with the urinary nitrite test provides an excellent screen for establishing the presence of a urinary tract infection (UTI). A urine sample that tests positive for both nitrite and leukocyte esterase should be cultured for pathogenic bacteria.

As far as the urinary tract is concerned, there are three types of epithelial cells, called, squamous, transitional and renal tubular cells. While squamous epithelial cells are found on the skin, in the vagina and outer parts of the urethra, transitional ones are located in the bladder, ureter and renal pelvis. Renal tubular cells are found in the nephrons of the kidney. As per microscopic analysis of the urine sediment, the epithelial cells in the urine are classified as per the type and quantity. The quantity is given as 'occasional', 'moderate', 'few' or many. As mentioned above, the presence of a few epithelial cells, especially, the squamous and transitional ones are considered as normal in both men and women. Presence of renal tubular cells are not normal and in large numbers, can be a sign of some serious kidney problem. Even large numbers of transitional cells can be an indication of serious conditions. Large numbers of squamous epithelial cells in urinalysis may also be due to contamination of the urine. The most common causes of epithelial cells in urine are infections, inflammation and malignancies. However, your health care provider can read the results of urinalysis and diagnose the problem.
 Thus, determining the type and quantity of epithelial cells in the urine will help in diagnosing the condition. For example, many transitional epithelial cells in urinalysis can be due to bladder infection.
Rubella IGg positive means that there was infection in the past and there are sufficient amounts of antibodies and this is considered as good and so there is nothing to worry on this account.
In nut shell there seems to be urinary tract infection in your wife and you must consult your doctor for diagnosing the exact cause and treatment.
I hope to have answered you in detail however you can revert to me for any further query.
Thanks and best of luck.
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