What does it mean if there are white blood cells and ketones present in urine?

Many things: Ketones can be found in your urine related to poorly controlled diabetes, an extremely low carbohydrate diet and resulting fat metabolism, dehydration and too much alcohol. White blood cells in your urine, so called pyuria, suggests some element of inflammation along the genitourinary tract. You could see this from infections, like a UTI, or even just from physical irritation of the urethra.

Infection/starvation: White blood cells (WBC) in the urine are considered a sign of infection. WBC can be due to contamination from surrounding tissues; this is more common in women. A culture needs to be done to diagnosis infection. Ketones in the urine are considered a sign of starvation. Ketones are the result of the breakdown of cells in the body, that occurs when the cells do not have adequate energy input.

See below: WBC can indicate a urinary tract infection. Ketones are seen when the body metabolizes fat for energy, instead of glucose. This happens during fasting or starvation. It also occurs with alcoholic and diabetic ketoacidosis. The presence of WBC is unrelated to the Ketones in the urine.