North American Registry of Midwives (NARM) Practice Exam

Which of the following symptoms is NOT typically associated with ketones in urine during labor?

1. Feeling weak

2. Circumoral pallor

3. Increased appetite

4. Elation

The correct answer is: Increased appetite

Ketones in urine during labor are often a result of the body breaking down fat for energy due to inadequate carbohydrate supply. This physiological shift can lead to various symptoms. Feeling weak can occur because energy levels are depleted when the body relies on fat breakdown instead of glucose for energy. This is a common consequence of nutritional deficiencies or prolonged labor. Circumoral pallor, which may appear as paleness around the mouth, can be an indicator of dehydration or low energy, both of which can be associated with the presence of ketones. Elation is related to heightened emotional states that can sometimes accompany physiological changes, including those associated with labor. However, it is not a direct symptom of ketones in urine. Increased appetite, on the other hand, is not typically associated with ketones in urine. When ketogenesis is occurring, it usually indicates that the body is in a state of energy deficiency, which often suppresses appetite rather than increases it. Thus, individuals do not typically experience increased appetite during this metabolic state, making it the correct answer.