Sunday, April 27, 2014

The Emergency Value of Dipstick Urinalysis

This is the back of the container to Urine Reagent Strips

       It is very important to amass your Family Medical Kit for home use, your Evacuation Medical Kit, and your Document Evacuation Bag.    These are priority.

              Assembling your Rehydration Kit is also of paramount importance.

             However, after this is done, you can expand your preps to include Childbearing Family Kit.

Again, it is my personally held belief that you should amass these items yourself rather than buying a premade kit, (with the exception of the birthing kit portion of the Childbearing Family Kit)  simply because in an emergency, even if you have personally prepared the kit, it can be difficult under stress to remember what is in it.  In emergencies, I have often used someone elses supplies not remembering that I carried the same item somewhere within my own kit.

Once all of this is done, there is something else that is very nice to have, but should not be purchased in advance of essentials.   This is a refinement.  This refinement can provide a lot of information as to what is going on with a sick person in an emergency.  It can provide tangible data you can relate to another medical person should you have telephone, walkie talkie, or HAM radio contact with a physician, nurse practitioner, or physician's assistant. Having urine reagent strips can allow you to run some degree of diagnostics and in tandem with communication, allowing you to have the benefit of input of people with medical training.

         Urine Reagent Strips can provide an awful lot of information on a sick person's general condition, and sometimes it can reveal a diagnosis.  Your physician's office uses them, even though they often send out urine and blood samples to a lab. This procedure is also known as a dipstick urinalysis.

        These can be purchased from the following link:

     One source for urine reagent strips
(For $19.00 you receive 100 tests.)

There are a number of different brands of this item.  The generic varieties are just fine and are used by hospitals and doctor's offices alike.  The expiration dates are usually one or two years ahead.  After they are expired, I order a new set for human beings, and then I mark the expired ones,  "veterinary" and then I use them for one or two years past stated expiration, and thus far, they have worked effectively on my furry friends. The vet also appreciates the extra information.

     You need:

1. A package of urine reagent strips
2. a plastic or paper disposable cup
3. paper towels to sit the urine cup on while you work
4. a watch with a hand which allows you to count seconds
5. decent natural or artificial light sufficient to see what you are doing
6. pen and paper to record results  You might wish to write out items in advance and fill in
    results as they reveal themselves.
7. a few vinyl medical gloves.  medical professionals do not touch body fluids. Wear the gloves throughout the procedure and until clean up is complete.

Familiarize yourself with the procedure for reading these results, before beginning.  Some items will need to be read in 30 seconds and others are two minutes.

      Urine reagent strips allow you to have your sick family member collect urine in a clean plastic or paper cup, and immediately dip the entire stick in the urine.  Then place the reagent strip on top of the cup itself, and begin timing.  Some items can be read in thirty seconds and others in two minutes. 

In twenty seconds read the items that are ready and record them on the paper.    Do the same at the two minute mark.  These are read by comparing the dipped stick with the color coded results on the back of the container. Make sure that you do not touch the wet stick to the container itself. (See the picture at the top of the page.)

Certainly in a blog post I cannot relate everything your physician or nurse knows about reading these strips, but here are some important points.

1. If you have the option of relating abnormal information obtained in a dipstick urinalysis to a medical practitioner, then do so.   Sometimes, you will only receive information that you can act upon yourself. Sometimes, all you will receive is completely normal information, and that is a very good thing.

These strips test for:

Specific Gravity
Leukocytes   (white blood cells)

Here we can see gloved hands and a dipped stick.  The person is reading each test on this particular brand of dipstick, ketone , then protein at 60 seconds, ph at 60 seconds, etc.

        In very general terms for the purpose of a blog post, many times you will notice positive nitrites, positive blood, and you may even see a small amount of positive protein.  This means that your family member is very likely to have a urinary tract infection.    Provide the results of this test to your doctor.  Some patients may already have treatment for such provided by their physician.  Pregnant women with urinary tract infections can go into premature labor, so this becomes a priority.

       A positive glucose reading in an adult who was not known to be diabetic is usually an indication that they are now.  This is also something a physician should be told about, particularly if this is a new finding.

       A positive glucose and ketone reading on a child's urine is an indicator of new onset Type I (juvenile) diabetes, and is a medical emergency.  This child must be transported to a hospital for immediate treatment. Meanwhile, if they are awake, have them drink as much water as they can with a pinch of Morton lite salt, which is potassium) to each 20 oz of water while you are transporting them for likely intravenous hydration, stabilization, and gradual insulin administration.

       A person with only a positive ketone, (and negative glucose)means that through either food restriction (diet) or illness that they are breaking down body fat or muscle for use as fuel.  They need addditional hydration and some carbohydrates.  (Water and food) They may also need an underlying issue treated.

A person with positive urobilinogen may have disease or blockage of the bile ducts or some type of liver disease. This can also be elevated during a fairly severe urinary tract infection.

Urine specific gravity may also be measured somewhat using the urinary dipstick.   A value of 1.008 is a dilute urine, meaning that the patient is hydrated and putting out a fair amount of fluid.  A specific gravity of 1.020 is a concentrated urine, and suggests a tendency toward dehydration.

 Generally, you can be less concerned about individual results on the urine dipstick and simply relate this information to a health care provider when you speak to them via telephone or text.  Understand also that prescription or OTC drugs you are taking can impact some of these results.    For example, in a man, blood found in the urine may indicate a urinary tract infection of kidney stones (renal calculi).   In a young woman, blood in the urinalysis could mean that she has her menses.

      Still, having 100 dipsticks available at your home, in a clean, dry dark place, that you spent $!9.00 US or so, makes sense.  It can provide important information to your doctor or health care provider.  It is also an essential element in the kit for diabetic sick day supplies (For both Type I autoimmune, and Type II diabetes mellitus patients)  It is also an essential element to the kit for the Emergency Kit for the Childbearing Family.


Practical Parsimony said...

So, after all of this is over, the pen and watch need to be part of the cleanup? If a proper urine sample is obtained, the menses blood should not be in the urine. Included in the supplies is there a sheet with instructions to the male and female patient on how to obtain a clean sample?

JaneofVirginia said...

The watch could be worn on the wrist above the vinyl glove. Usually simply dipping the stick in the urine and gently placing it on top of the cup doesn't splash the watch.
Yes, if one does a clean catch urine, LESS blood will be detected in the sample than it would otherwise in a menstruating woman. However, there will still be sufficient blood microscopically in the sample, to test positively for blood. The best course is to do the test anyway, noting on the paper that the patient is menstruating. The test can be repeated when her menses is complete. In a urinary tract infection other indicators besides blood would be positive, like nitrates and often small amounts of protein (from mucus shreds and casts which are often found in the urine of someone with cystitis.)
Although most people do not have the benzalkonium chloride wipes which are often found at doctor's offices, catching the sample of urine in the middle of a urine stream goes a long way to avoid a contaminated sample. Best wishes.

Practical Parsimony said...

I have never been given any kind of wipe! I can tell from the beginning that I have a uti. I don't know if most people feel as wiped out as I do. Thanks.

JaneofVirginia said...

The ideal procedure when obtaining urine for urine culture, in order to identify the causative organism with certainty, is to provide the patient with a benzalkonium wipe which should be used front to back. Then, urine should be caught in the middle of the stream in the cup. The urine from the beginning of the stream may have WBCs and possibly even RBCs. The urine from the end of the stream might also as the bladder folds in on itself. The urine from the middle of the stream should be the best indicator as to degree of infection, amount of blood, and should allow us to culture the causative organism in order to select or ascertain that the correct antibiotic was given.
Of course, d-mannose is an effective treatment to many uncomplicated UTIs that are caused only by E-Coli. It is not effective for UTIs of any other cause.