Two plus signs in urine ketone bodies suggest a combination of ketosis, which is generally caused by two clinical conditions. One condition is diabetic ketosis. In diabetic patients, because of poor blood glucose control and insulin deficiency, the body cannot effectively use glucose for energy metabolism and can only carry out fat oxidation and decomposition to ensure the body’s energy needs. This process produces a large amount of ketone bodies, which exceeds the metabolic capacity of the liver, and the excess is excreted in the urine, producing the phenomenon of urinary ketone bodies plus. This condition is an acute complication of diabetes and requires urgent medical attention. The second condition is starvation ketosis. It is mainly seen in patients who eat poorly for various reasons, or in patients who have lost weight and eat very few carbohydrates, without sufficient carbohydrates in the body for energy supply, the same fat oxidation and decomposition will take place, producing ketone bodies. This ketosis should encourage patients to eat or rehydrate in time, and the ketone bodies will be eliminated.