3.4.5 Urinalysis Case Study #1 Bekah O’Bryan, Hailey Nealen, Ashton Crowe

Case Study #1—The Story (Subjective) A 40-year-old, overweight, pregnant woman comes in for her routine appointment. She is 28 weeks pregnant, complaining that she is constantly thirsty and saying that she spends all of her time running to the bathroom. She has been feeling more lethargic than normal lately and she has lost some weight. No abnormal cells were found in her urine sample. Case Study #1—The Story (Subjective)

Control Urinalysis Values Urine Color: straw Glucose in Urine: Negative Clarity of the Urine: clear Ketones in Urine: Negative pH of the Urine: 5 Erythrocytes: Negative Specific Gravity of the Urine: 1.005 Leukocytes: Negative Protein in Urine: Negative

URINALYSIS RESULTS (Objective Data) Urine Color: straw Protein in Urine: Negative Clarity of the Urine: mostly clear Glucose in Urine: 5000+ (60) pH of the Urine: 5 Ketones in Urine: 3.5 Specific Gravity of the Urine: 1.015 Erythrocytes: Negative Leukocytes: Negative

WHAT DOES THIS MEAN? Color is ok Glucose is not ok(too high) Clarity is ok Ketones are not ok(too high) pH is ok Specific gravity is ok Erythrocytes are ok Proteins are ok Leukocytes are ok

Differential Diagnosis Gestational diabetes (only occurs when pregnant usually in the 2nd trimester) can be ruled out/in by further testing like glucose tolerance test. Diabetes Insipidus (rare form metabolizing salts) ruled in/out by a fluid depravation test. Diabetes mellitus (type 1 or 2) can be ruled in/out by an insulin test, glucose tolerance test, or A1C test.

Gestational Diabetes Defined as: “Pregnant women who have never had diabetes before but who have high blood glucose (sugar) levels during pregnancy are said to have gestational diabetes.” Symptoms Include: Excessive thirst, Excessive hunger, Fatigue, Frequent urination, Yeast Infections, Snoring, Weight loss, High blood pressure. Fact: It is mostly prevalent in the second trimester– 9.2% of women develop it during pregnancy. Cause: During pregnancy, the placenta makes hormones that can lead to a buildup of sugar in your blood. Usually, your pancreas can make enough insulin to handle that. If not, your blood sugar levels will rise and can cause gestational diabetes.

Diabetes Mellitus Diabetes mellitus (or diabetes) is a chronic, lifelong condition that affects your body's ability to use the energy found in food. Cause: With diabetes mellitus, either your body doesn't make enough insulin, or it can't use the insulin it does produce, or a combination of both. Symptoms: Frequent urination, Excessive thirst, Unexplained weight loss, Extreme hunger, Sudden vision changes, Tingling or numbness in the hands or feet, Feeling very tired much of the time, Very dry skin, Sores that are slow to heal, More infections than usual.

Diabetes Insipidus An uncommon disorder characterized by large amounts of water being excreted as diluted urine. Symptoms Include: Intense thirst (despite drinking fluid) known as polydipsia, the excretion of large amounts of urine(polyuria) Cause: Your body improperly producing, storing, and/or releasing the hormone ADH.

Patient 1 has gestational diabetes. DIAGNOSIS

How did the urinalysis results lead you to your diagnosis? The urinalysis itself guided us in diagnosing our patient because it showed us that her glucose and ketones were elevated. Ketone is a chemical that is produced when there is a shortage of insulin in the blood. This causes the body to begin breaking down body fat for energy. The discovery of ketones in urine is a sign that your body is using fat for energy instead of using glucose because not enough insulin is available to use glucose for energy.

What led us to this conclusion? Besides the urinalysis results, we had suspicions that the patient have gestational diabetes. Patient 1 was experiencing weightloss, but she was also overweight. She was 28 weeks pregnant(2nd Trimester) and she complained that she was constantly thirsty and that she was urinating frequently. She also mentioned that she was feeling more fatigued recently.

Affected Systems/ Organs Endocrine System- Your pancreas is one of the most connected organs to diabetes. Secreting and producing insulin which controls the blood glucose levels. When the body rejects this insulin or no longer produces insulin other substitute hormones are made in place of insulin to break fat down into energy. This can explain why the Ketone levels where so elevated in our patient. The endocrine system can also effect other body systems. Circulatory System- High blood glucose levels can lead to fatty deposits in the blood stream and cause plague built up in the arteries. Narrow blood vessels can lead to infections and strokes or blood clotting in the body.

Affected Organs/Symptoms Nervous System- Diabetes can affect the nerves that controls the body temperature perception and your pain levels. No longer being able to have a hot or cold sensation can cause the body to not be able to function at its highest potential. Also when there is no pain reception there can be major injuries that may feel minor or even unnoticed injuries that can become infected with time. Urinary System- Diabetes damages your kidneys affecting their abilities to filter water and create urine. Elevated amounts of proteins can begin to surface in the urine and can then lead to kidney disease. When the kidneys no longer function properly the body may become dehydrated and can lose valuable resources such as glucose and electrolytes.

Further Testing Glucose Tolerance Testing: This is very similar to the Initial Glucose Challenge Test except you'll fast overnight, then have your blood sugar level measured. Then you'll drink another sweet solution — this one containing a higher concentration of glucose — and your blood sugar level will be checked every hour for three hours. A1C Testing: This is a blood test that is checking your blood glucose. Initial Glucose Challenge Test: This test includes drinking a syrupy glucose beverage and having blood drawn in certain increments like every hour for 4 hours to see how quickly your body absorbs the glucose.

How to Treat Gestational Diabetes Monitor your blood sugar throughout the day Eat a healthy diet Exercise Be extra preventative with healthcare screening for yourself and your baby Medication (if uncontrollable) This includes oral drugs like metformin or Glumetza or even an injectable insulin like novolog, lantis, etc

The peak: is the time the insulin is working the hardest to lower your blood glucose The onset: is how soon the insulin starts to lower your blood glucose after you take it Our Plan

SOURCES Diabetes. (nd). Checking for Ketones. [accessed 24 February 2016]. Retrieved from: http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose- control/checking-for-ketones.html?referrer=https://www.google.com/ Mayo Clinic. (nd). Gestational Diabetes. [accessed 24 February 2016]. Retrieved from: http://www.mayoclinic.org/diseases-conditions/gestational-diabetes/basics/treatment/con- 20014854 Healthline. (nd). The Effects of Diabetes on the Body. [accessed 24 February 2016]. Retrieved from: http://www.healthline.com/health/diabetes/effects-on-body Web Md. (nd).Gestational Diabetes. [accessed on 25 Feb. 2016]. Retrieved from: http://www.webmd.com/diabetes/gestational-diabetes-guide/gestational_diabetes Web Md. (nd).Diabetes Mellitus and Insipidus. [accessed on 25 Feb. 2016]. Retrieved from: http://www.webmd.com/diabetes/guide/types-of-diabetes-mellitus