Desiree Foster
WAM
7/18/2012 Today I will discuss a patient’s urinalysis report. She is a 43 year old African American woman. She was diagnosed and is being treated for depression. She also has a case of bilirubin and urobilinogen. To do a proper urinalysis we would have to conduct a clean catch sample. A clean catch sample is a urine-specimen that is a free of bacterial contamination as possible without the use of a catheter. The main purpose of this urine sample is to test the abnormities that may be present, such as bacteria, ketones or drugs. When this test is conducted we are looking for different things like color distortion, texture (cloudy, clear, and pale), smell and etc. When there is color distortion it can come from different foods eaten, drugs that were taken or even health problems. The types of colors can be a clear or helpful indictor of what is going on with you. I will give you some examples of color and the meaning of them and also give detail of our patient. Red urine indicates blood by hematuria and this is usually dark from the normal light color. Yellow can be caused by dehydration or also foods that are being taken. Orange can be caused by dehydration or jaundice which can make the bile show up in urine. Some fruits can cause this orange like color also; such as blackberries, beets, rhubarb and senna herbs. The best kind of urine a person wants to have is clear kind of pale color. This is a good indicator that a person is healthy. The clearer it is the healthier you are. Now when we look at our patient since she was diagnosed with diabetes; with that her urine would be a clear almost cloudy yellow color. With the medication for her depression added to the mix it would still be the same color. Having clear urine can also sometimes mean you have diabetes. To be sure to if a person has diabetes let’s ask some questions:
 Am I thirsty all the time?
 Do I drink more than eight glasses a day?
 has my frequency to urinate increase?
A person who has answered yes to these would then take a diabetes test. Now with our patient there were traces of bilirubin and urobilinogen. These are very similar to each other. When given a urine test the bilirubin will show up as dark amber (red); which tells us that the liver is impaired and the drainage is blocked. The conjugated bilirubin leaks out of the hepatocytes and appears in urine. The urobilinogen is colorless but might show up pink on the lab. For our patient the urine sample would come back to be a cloudy mid-red if she wasn’t on depressants; in which it would tell us that there is cirrhosis of the liver or some kind of autoimmune disorder. Now let’s talk about specific gravity. Specific gravity is a lab test that measures the concentration of all chemical particles in the urine. This test requires a clean catch sample. This test helps evaluate your body’s water balance and urine and also the concentration. Normal value readings for specific gravity would range 1.002 to 1.030. To better understand specific gravity there are two in which we describe there is low specific and high specific. The high specific gravity can be due to Addison’s disease, dehydration, diarrhea, heart failure, and shock. Low specific gravity can be due from excessive fluid intake, diabetes insipidus-centra, nephrogenic, kidney failure and kidney infection (pyelonephritis). When you do not drink fluids, your kidneys make urine with a small amount of water in it which has a high specific gravity. Most likely our patient has excessive fluid intake and since she has diabetes she would have to take the low specific gravity test. In her test we found that her specific gravity is 1.010 which is normal. While we have our urine test we will look to see to if the patient has the following in her urine: nitrites, leukocytes, protein, glucose, ketones, urobilinogen, bilirubin and blood. Since proteins rarely show up in the urine and there is no sign of it in our patient we can cross that off our list. Nitrites are a bacterium that causes a urinary tract infection. This makes the enzyme that changes urinary nitrates to nitrites. In this case the patient has no sign of an UTI. So the finding of nitrites we can cross off our list. Since our patient has tested positive of bilirubin we see that her urine would turn a cloudy dark red. The red comes from the breakdown of hemoglobin which is the components in red blood cells. The main pathway of bilirubin excretion is by urine and into bile. It is responsible for the yellow in urine, brown color of feces and the yellowish coloration in jaundice. The urobiliogen can be reabsorbed and excretion into urine turning it yellow. So since the urobiliogen turns urine yellow added with the diabetes and depression medication it keeps it clear and yellow instead of red. Our patient also shows signs of glucose in her urine due to her diabetes. In terms the sugar spills over into the urine; which makes the blood sugar really high. In normal testing there is very little or no glucose in urine at all. Another indicator is when glucose is found in urine when the kidneys are damaged or diseased. One more example of what could be found in the urine is ketones. This is when fat is broken down for energy and is passed through the urine. It is very serious and dangerous when large ketones go through the urine which is called ketoacidosis. In this case our patient doesn’t have this going on. Next I will talk about the PH levels of urine. If a person that has high pH in urine it is called alkaline and it is caused by kidney failure and UTI. A very low pH is called acidulous and it can be caused by complicated diabetes, lung disease, starvation and diarrhea. The healthiest urine pH reading is around 7.0, usually fluctuating between 6.5 and 7.5. Since our patients urine is the pH of 5 it would be very acidic. I would believe that since the patient is on depressants the medication is being metabolized through the liver and basically killing it. Medications that lake the ingredients of calcium, magnesium, potassium and sodium which helps your body’s pH to even itself out if not is it very dangerous; so without these substances the body becomes more acidic. So in conclusion our patient is a 43 year old African American with diabetes. She has been treated and is taking depression medication. There are also traces of bilirubin and urobiliogen in the urine. So her urine would have traces of glucose and some sites of blood. It would be clear and yellow due to the diabetes and urobiligen. In her case the urine test would come up normal and negative. Her urine pH is a 5 due to the cirrhosis of her liver added on top of the antidepressants she is taking. The specific gravity test came to be a 1.010 which is in the norm. She may be diagnosed with dehydration and may have excessive fluid intake because of the liver infection and diabetes. In her case she would have to do follow-ups with her physician to make sure she is on the right track.

Bibliography: www.healthline.com www.urinecolors.com www.medicinenet.com Human Anatomy and Physiology/ Elaine N. Marieb, Katja Hoehn.-8th ed.