Unit Converter
Acetone
Synonyms
- Dimethyl ketone
- Propanone
- β-Ketopropane
- Ketone body (volatile ketone)
- Acetone (standard clinical name)
Units of Measurement
mmol/L, mg/L, mg/dL, mg/100mL, mg%, µg/mL
Description
Acetone is one of the three major ketone bodies, along with:
- Acetoacetate (AcAc)
- β-Hydroxybutyrate (BHB)
Acetone is formed spontaneously by decarboxylation of acetoacetate and is the least abundant ketone body in the blood. It is volatile and excreted through:
- Breath (fruity odor)
- Urine
- Lungs (primary route)
It serves more as a marker of ketosis rather than a metabolic fuel.
Clinically, acetone levels rise in states of:
- Diabetic ketoacidosis (DKA)
- Alcoholic ketoacidosis
- Starvation/fasting ketosis
- Low-carbohydrate or ketogenic diets
- Isopropyl alcohol poisoning (important toxicology clue)
Physiological Role
Acetone itself does not contribute significantly to energy production.
It is a byproduct of ketone metabolism.
Formation pathway:
Acetoacetate → (spontaneous decarboxylation) → Acetone
It accumulates when:
- NADH/NAD⁺ ratio is high
- Acetoacetate production is excessive
- Ketosis becomes prolonged or severe
Since it is volatile, it causes the characteristic “fruity breath odor” in DKA.
Clinical Significance
Elevated Acetone
Seen in:
- Diabetic Ketoacidosis (DKA)
- Alcoholic ketoacidosis
- Starvation ketosis
- Ketogenic diet
- Pregnancy ketosis
- Isopropyl alcohol ingestion (acetone is a major metabolite)
Low/Normal Acetone
Occurs in:
- Normal metabolism
- Early DKA (BHB predominates)
- Adequate carbohydrate intake
Reference Intervals
| Sample | Reference Range |
| Blood (serum) | < 0.3 mmol/L (typical physiological level) |
| Ketonemia range | 0.3 – 1.0 mmol/L |
| Ketoacidosis range | > 1.0 mmol/L |
| Urine | Negative to trace in healthy individuals |
Note: β-hydroxybutyrate is the preferred test in DKA because BHB rises first and much higher than acetone.
Toxicology Point: Isopropyl Alcohol Poisoning
In isopropanol ingestion:
- Acetone rises sharply
- Osmolar gap increases
- Ketosis without acidosis
- Glucose is normal
This helps differentiate isopropyl alcohol poisoning from DKA.
Unit Meanings
| Unit | Meaning |
| mmol/L | millimole per liter |
| mg/L | milligram per liter |
| mg/dL | milligram per deciliter |
| mg/100mL | same as mg% |
| mg% | milligram per 100 mL |
| µg/mL | microgram per milliliter |
Analytical Notes
1) Breath Acetone
Fruity odor on breath is classic for:
- DKA
- Prolonged fasting
- Ketogenic diet
Breath testing is used in ketogenic diet monitoring.
2) Urine Ketone Tests
Nitroprusside tests detect mainly Acetoacetate and Acetone,
NOT β-hydroxybutyrate.
Hence:
- Negative urine ketones do NOT rule out DKA.
- Serum BHB is preferred for diagnosis.
3) Sample Handling
Acetone is volatile -avoid prolonged sample exposure to air.
Clinical Pearls
- In DKA, β-hydroxybutyrate rises first, not acetone.
- Breath acetone correlates loosely with ketosis but is not diagnostic.
- Isopropanol poisoning produces very high acetone without acidosis.
- Urine ketone dipsticks largely reflect Acetoacetate and Acetone, not true ketone burden.
Interesting Fact
Acetone was one of the earliest organic compounds identified in human breath (1857).
Today, breath acetone is being explored as a non-invasive biomarker for fat oxidation and metabolic status.
References
- MedlinePlus -Ketone tests and breath acetone.
- Tietz Clinical Chemistry and Molecular Diagnostics, 8th Edition -Ketone bodies and volatile metabolites.
- Mayo Clinic Laboratories -Ketone Body Interpretation.
- IFCC Guidelines -Ketone Testing & DKA.
- ARUP Consult - DKA and ketone markers.
- NELSON Toxicology - Isopropanol poisoning & acetone metabolism.
- American Diabetes Association - DKA criteria.