ketonuria in acute abdomen of preschool children without a history of diabetes mellitus

The preschool children have had problem in diagnosis of appendicitis because of poor history taking and inappropriate response to physical examination. The leukocytosis with differential counts or C reactive protein as indicators of inflammation were not to predict further invasive evaluation like immediate computed tomography or intraabdominal sonography in acute abdomen. The hyperketonemia without past history of diabetes mellitus have been used a indicator to decide severity of illness for admission and treatment. So ketonuria was not qualified test for ketoacidosis, but it might be helpful. Therefore if preschool child had positive ketonuria and abdominal pain, then immediate computed tomography or abdominal ultrasonography should be done to rule out surgical diseases like appendicitis. And urinalysis should be absolutely neccesory procedure in emergency room.