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 gravity with respect to the urine okay let’s get started withglucose we use a peroxide approach which will become important last-minute this is why we useperoxides to measure glucose a peroxide action 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 numeral that you shouldknow for glucose is called the TM which stands for the transport maximum and inthis case that amount is 180 micrograms per deciliter which means that if theglucose absorption were 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 envision on a test on aurine measure it’s either good to be negative or it’s going to be positiveand units of positivity as we spoke before there is a way to make thisthing a fallaciou negative and so you have to be careful that if the patient istaking the high rates of vitamin C that they are able mayglucose even though there is glucose in the urine it is possible to make it ogle 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 approximately 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 construe a positive glucose going on what does that aim there’s two possibilitiesusing our analogy either you’ve got a bad wall okay that meant that the damnwall is not holding back the sea and it’s divulging 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 illnes with Vanko knee syndrome youhave a problem with reabsorption at the proximal convoluted tubules so you alsosee dumping of phosphate you’ll also understand dropping of uric acid you’ll too 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 see that comes dumped our amino battery-acids now what arethings that can cause this Vanko knee syndrome well it could have somethingcalled variou myeloma that is a cancerous cancer where you have plasmacells that’s overpopulate all the things that could do this would be heavy metalsother things that could do this would be drugs for instance 10 of therewhich is an HIV medication chemo therapeutic operators likecisplatin can do it another medication that’s used in mood agitations that’svpa or valproic battery-acid and then antibiotic which is used routinely isaminoglycosides so that would be like gentamicin tobramycin amikacin so immunoclyde’s can do this so all of these compels 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 kind 2you could have even gestational diabetes that could be used to do it and anything basicallythat will increase your blood glucose for instance Cushing’s disease thatcould do it and that roll goes jolly deep so those are the causes of glucosein the urine okay let’s deepen up the colouring a little let’s talk aboutketones so ketones in the urine it’s not often as helpful as serum ketones nowthat those are more available 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 specific 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 solely are where fatty acids get transported into the matrix ofthe mitochondria where something called beta oxidation arises and beta oxidationtakes fatty acids and changes them into acetic awaywhich are two carbon contingents so these two carbon units if there’s a good deal of thisfatty battery-acid change into two carbon cells a great deal of acids filled Kawaibecomes available and ordinarily 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 gapes somewhat like this and you bind thesetogether you’re going to do things like acetoacetate and beta-hydroxybutyrate and acetone if you have 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 can 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 evaluation that checks for exclusively acetoacetate andthe behavior it does that is through this nitroprusside reaction which involvesnitro for a cyanide which turns it a nice purplish blue-blooded and that’s why we’rekind of writing it in off-color 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 come this purple colorthat’s going to turn the ketones positive but there’s also differentlevels of positive there’s draw there’s 1+ 2+ 3++ 4+ and so for discover thatworks out to be about 5 milligrams per deciliter 1+ is 15 2+ is 43+ is 80 +4+ ultimately is about 160 or more thing now that you should know is that ifketones are positive you really should be checking them in the serum

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