Urinalysis Interpretation Explained Clearly – Glucose & Ketones in Urine

okay well welcome to 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 method which is increasingly becoming important last-minute so 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 list that you shouldknow for glucose is called the TM which stands for the transport maximum and inthis case that number is 180 micrograms per deciliter which meant 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 something else so again remember peroxidase andalso 180 milligrams per deciliter okay so what you’re gonna visualize on a test on aurine research it’s either good to be negative or it’s going to be positiveand severities of positivity as we talked about before there is a way to make thisthing a false negative and so you have to be careful that if the patient istaking the high rates of vitamin C that can mayglucose even though there is glucose in the urine it could make it gaze 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 watch a positive glucose going on what does that mean there’s two possibilitiesusing our resemblance either you’ve got a bad wall okay that meant that the damnwall is not holding back the liquid and it’s disclosing 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 firstly thisis sometimes known as fan Kony’s condition with Vanko knee syndrome youhave a problem with reabsorption at the proximal convoluted tubules so you alsosee dropping of phosphate you’ll too read dumping of uric acid you’ll also 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 form 2 okay and that gets into the pH and then of coursethe other thing that you see that goes dropped our amino battery-acids now what arethings that can cause this Vanko knee syndrome well it could have somethingcalled multiple myeloma that is a cancerous malady 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 medications for instance 10 of therewhich is an HIV medication chemo therapeutic negotiators likecisplatin can do it another medication that’s used in mood confusions that’svpa or valproic acid and then antibiotic which is used customarily isaminoglycosides so that would be like gentamicin tobramycin amikacin so immunoclyde’s can do this so all of these effects 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 most difficult one there you gotto know about is diabetes and of course you can have nature 1 you are eligible to have form 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 directory becomes somewhat deep so those are the causes of glucosein the urine okay let’s vary up the hue a little let’s talk aboutketones so ketones in the urine it’s not generally 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 cadre you’ve got the nucleus ofcourse but you’ve got these mitochondria all throughout and in the mitochondriainside them solely are where fatty battery-acids get transported into the matrix ofthe mitochondria where something announced beta oxidation comes and beta oxidationtakes fatty acids and converts them into acetic awaywhich are two carbon parts so these two carbon gangs if there’s a lot of thisfatty acid changeover into two carbon gangs a lot of acids filled 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 are dealing with then they start to coalesce with each other and so if youhave this a steel Kawai which seems rather 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 test that are searching for exclusively acetoacetate andthe course it does that is through this nitroprusside reaction which involvesnitro for a cyanide which turns it a nice purplish off-color and that’s why we’rekind of writing it in off-color here 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 purple colorthat’s going to turn the ketones positive but there’s also differentlevels of positive there’s trace there’s 1+ 2+ 3++ 4+ and so for trace thatworks out to be about 5 milligrams per deciliter 1+ is 15 2+ is 43+ is 80 +4+ finally 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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