Urinalysis Interpretation Explained Clearly – Glucose & Ketones in Urine

okay well therefore welcomed another MedCramlecture we’re going to talk about your analysis again and this time we’re gonnago into with the urinalysis of glucose ketones bilirubin urobilinogen andspecific seriousnes with respect to the urine okay let’s get started withglucose we use a peroxide technique which is increasingly becoming important later we are therefore useperoxides to measure glucose a peroxide reaction and the thing that you shouldknow that’s important is that when blood goes to the nephron there is a barrierthere in the nephron that is preventing glucose from being spilled into Bowman’scapsule and the proximal convoluted tubuleso if you can kind of imagine a obstruction with a wall and there is water so long as thewater doesn’t go over that damn wall there won’t be spillage over it that’sthe same analogy that we use with glucose and the figure that you shouldknow for glucose is called the TM which stands for the transport maximum and inthis case that digit is 180 micrograms per deciliter which meant that if theglucose concentration be higher than 180 milligrams per deciliter then therecould be spillage of glucose into the urine but if it is less than 180 milligrams per deciliter there should not be now if you do get that you’regonna have glucose that’s gonna be found in the urine and that has the effect ofdrawing in fluid because of its osmotic principle and you’re gonna get anosmotic diuresis but we’ll talk about that so again remember peroxidase andalso 180 milligrams per deciliter okay so what you’re gonna determine on a test on aurine test it’s either good to be negative or it’s going to be positiveand stages of positivity as we talked about before there is a way to make thisthing a fictitiou negative and so you have to be careful that if the patient istaking high levels of vitamin C that they are able mayglucose even though there is glucose in the urine it is possible to make it gape negativeso there are things that can metabolize the vitamin C’s so you don’t get thosefalse negatives just so you’re aware in terms of positive you could have a traceyou can have a 1 plus a 2 plus a 3 plus and a 4 plus and these generally areassociated with nearly 100 milligrams per deciliter 250 500 athousand and up to 2,000 milligrams per deciliter in the urine okay so you couldget quite a bit of spillage of glucose in the urine okay so what does this meanyou appreciate a positive glucose going on what does that mean there’s two possibilitiesusing our analogy either you’ve got a bad wall okay that means that the damnwall is not holding back the ocean and it’s leaking out or you’ve got spilloverokay so the bad wall is much more rare andthe spillover is much more common so let’s talk about the bad wall first thisis sometimes known as fan Kony’s disorder with Vanko knee syndrome youhave a problem with reabsorption at the proximal convoluted tubules so you alsosee dumping of phosphate you’ll likewise view dropping of uric battery-acid you’ll likewise seedumping of bicarbonate now if you remember if you don’t reabsorbbicarbonate well at the proximal convoluted tubule this is known as arenal tubular acidosis category 2 okay and that does into the pH and then of coursethe other thing that you be understood that gets dumped our amino acids now what arethings that can cause this Vanko knee syndrome well it could have somethingcalled variou myeloma that is a cancerous canker where you have plasmacells that’s overpopulate all the things that could do this would be heavy metalsother things that could be used to do this would be medications for example 10 of therewhich is an HIV medication chemo therapeutic agents likecisplatin can do it another medication that’s used in mood ruffles that’svpa or valproic acid and then antibiotic which is used often isaminoglycosides so that would be like gentamicin tobramycin amikacin so immunoclyde’s can do this so all of these crusades can cause the Fanconi syndromewhere we have a bad wall so in terms of spillover though where the wall is finebut you just have too much glucose in the blood the biggest one there you gotto know about is diabetes and of course you can have kind 1 you are eligible to have nature 2you could have even gestational diabetes that could do it and anything basicallythat will increase your blood glucose for instance Cushing’s disease thatcould do it and that listing departs fairly deep so those are the causes of glucosein the urine okay let’s mutate up the hue a little let’s talk aboutketones so ketones in the urine it’s not usually as helpful as serum ketones nowthat those are more accessible so this is kind of an older test the way that thoseare checked for is something that you should know called the Nitro pro sidetest so what are the major reasons why somebody would have ketones in theirurine one of them is alcohol so alcoholic ketosis another one would beof course DKA which is diabetic ketoacidosis and then finally the lastone would be starvation ketoacidosis so what are ketones precisely well thething that you’ve got to remember is in the cell you’ve got the nucleus ofcourse but you’ve got these mitochondria all throughout and in the mitochondriainside them precisely are where fatty battery-acids get transported into the matrix ofthe mitochondria where something called beta oxidation comes and beta oxidationtakes fatty battery-acids and alters them into acetic awaywhich are two carbon components so these two carbon gangs if there’s a great deal of thisfatty acid alteration into two carbon components a good deal of acids crowded Kawaibecomes available and normally that acetic away as you already know shouldgo into the krebs cycle but if there’s too much of it around and the krebscycle can’t be dealt with then they start to coalesce with each other and so if youhave this a steel Kawai which inspects moderately like this and you bind thesetogether you’re going to get things like acetoacetate and beta-hydroxybutyrate and acetone “if youre having” two of theseyou’re going to make one acetoacetate and what does the COS state look like itlooks like this there’s one two three four carbonsnow acetoacetate is likely to be converted and goes back and forth tobeta-hydroxybutyrate to look like this and as you can see here we have acarbonyl group being reduced to a hydroxy group and so because this isbeing reduced something has to be oxidized and that’s where you take and aD H and you oxidize it to n a D+ so you can get beta-hydroxybutyrate you can getacetoacetate of course what you can do is you could simply really chop off theco2 and then what you would get then is simply acetone which you breathe off sowhen you do the nitroprusside assessment that checks for specific acetoacetate andthe road it does that is through this nitroprusside action which involvesnitro for a cyanide which turns it a neat purplish off-color and that’s why we’rekind of writing it in blue-blooded now and what the hell is you getso with ketones you’re either going to get a negative or a positive and if youget a negative or positive you’re gonna get this violet colorthat’s going to turn the ketones positive but there’s also differentlevels of positive there’s retrace there’s 1+ 2+ 3++ 4+ and so for mark thatworks out to be about 5 milligrams per deciliter 1+ is 15 2+ is 43+ is 80 +4+ lastly is about 160 or more thing here that you should know is that ifketones are positive you really should be checking them in the serum


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