Brief Answer:
Ketones in the urine are normally high in some patients. Bilirubin in urine warrants blood tests for liver function- treatment will depend on the cause.

Detailed Answer:
Hello and welcome to "Ask a Doctor" service,

I carefully read your query and understand your concern.

The trace of ketones in the urine is very common and nothing to worry about. This index is important especially in patients with diabetes to check for complications of diabetes. In other patients, it is not a source of complaint as it may indicate fasting states (if you have not eaten for some hours, you are exercising a lot, you are reducing carbohydrates in your diet, in case of nausea or vomiting or in problems with the digestive problems.

As for bilirubin, this should not be high in urine analysis. If high bilirubin is noticed in urine, blood tests should be done to check liver function tests such as AST, ALT, Bilirubin in blood, ALP, etc. According to the results of these tests, other tests may be indicated such as tests for hepatitis A, B, C, abdominal ultrasound, etc.
If all the liver tests come out normal then very likely this is a false positive result (urine bilirubin levels may come out high while they are normal, but this needs to be confirmed by ruling out liver problems first).

To conclude:
- the trace of ketones in the urine is quite normal and nothing to worry about, drinking plenty may reduce it to normal
- bilirubin levels in urine may be due to liver problems or may be a false positive result (shows positive but it is not- this may happen often). Checks need to be done do find out which is the cause. If liver problems are identified, the treatment will depend on the diagnosis.

I hope this answers your query.
I remain at your disposal in case further medical assistance is needed.

Regards,
Dr. Antoneta Zotaj,
General and Family Physician

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