APPENDIX C: ABNORMALITIES DETECTION

Urine Dipstick: A dipstick — a thin, plastic stick with strips of chemicals on it — is placed in the urine to detect abnormalities. The chemical strips change color if certain substances are present or if their levels are not normal. The color variation often is indicative of how severe the abnormality is. Urine dipsticks are another tool and indicator to measure a patient’s well-being. Its values should be included in the “whole patient” approach to the medical evaluation. A dipstick test checks for:

- Acidity (pH). The pH level indicates the amount of acid in urine. Abnormal pH levels may indicate a kidney or urinary tract disorder or a potential systemic infection – sepsis.
- Concentration. A measure of concentration, or specific gravity, shows how concentrated particles are in your urine. A higher than normal concentration often is a result of not drinking enough fluids. In the setting of sepsis, it is a sign of clinically significant volume depletion.
- Protein. Low levels of protein in urine are normal. Small increases in protein in urine usually are not a cause for concern, but larger amounts may indicate a kidney problem.
- Sugar. Normally the amount of sugar (glucose) in urine is too low to be detected. Very high levels of glucose, especially when ketones are also elevated and pH decreased, can indicate diabetic ketoacidosis which may mimic sepsis. This can occur in individuals who were not previously aware they are diabetic and is a life-threatening condition, obtain telemedicine consult.
- Ketones. As with sugar, high levels of ketones detected in your urine could be a sign of diabetic ketoacidosis. Ketones in urine may also be a sign of malnutrition and protein-calorie deficit in the septic patient that should prompt consideration of starting caloric intake or enteral nutrition.
- Bilirubin. Bilirubin is a product of red blood cell breakdown or bile synthesized in the liver. Normally, bilirubin is carried in the blood and passed into the liver, where it is conjugated and becomes part of bile. Bilirubin in your urine may indicate liver damage, bile duct obstruction, or hemolysis (e.g., distributed intravascular coagulopathy).
- Evidence of infection. If either nitrites or leukocyte esterase — a product of white blood cells — is detected in your urine, it may be a sign of a urinary tract infection or systemic infection – sepsis.
- Blood. Blood in your urine requires additional testing — it may be a sign of kidney damage, infection, kidney or bladder stones, kidney or bladder cancer, or blood disorders.