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Gyorgy Csako, MD; Ronald J. Elin, MD, PhD
National Institutes of Health Bethesda, Md

JAMA. 1993;269(13):1634.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.

—There are a growing number of drugs that are present in the blood and/or excreted in the urine as free-sulfhydryl compounds. This list includes established drugs like dimercaprol (British antilewisite, BAL), penicillamine, cysteine, and acetylcysteine, plus newer drugs like mesna (or dimesna) and captopril. In alkaline medium, free-sulfhydryl compounds react with a purple color similar to that of ketone bodies (acetoacetic acid and acetone but not β-hydroxybutyric acid) in the nitroprusside test.¹ Since the nitroprusside test is used currently in all commercial dipsticks and in the Acetest tablet assay (Ames) for the detection of ketone bodies in urine and blood (serum), the positive interference with free-sulfhydryl compounds is of great importance, particularly in diabetics² and in those with suspected hepatocellular injury (eg, acetaminophen poisoning³ and chemotherapy).^1,4 Documented cases of patients who received or almost received inappropriate therapy with insulin due to spurious ketonuria . . . [Full Text PDF of this Article]

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