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Aubflab M3u2
Aubflab M3u2
Aubflab M3u2
A.Y. 2022 – 2023 | MLS 321 ANALYSIS OF URINE AND BODY FLUIDS
UNIT 2: GLUCOSE, OTHER REDUCING SUGARS AND KETONES
Laboratory
Summary
I. Tests for Glucose in Urine
A. Reagent Strip tests
B. Copper Reduction Tests (Benedict’s Test)
C. Other Qualitative Tests
1) Fehling’s Test
Determination
2) Haine’s Test
3) Trommer’s Test sugars are not normally excreted in urine
4) Nylander’s Test • only glucose and galactose signify pathologic conditions.
5) Moore – Heller’s Test • Glucose is the most commonly encountered sugar.
6) Phenylhydrazine Test (Osazone Test) • In children below (2) years, test for galactose since it is
7) Kowarsky Phenylhydrazine Test commonly implicated in galactosemia.
(Blumel’s modification)
• Recommended: Fasting prior to the collection of samples
8) Glucose Oxidase Paper Strip Test
for glucose screening tests.
D. Other Quantitative Test
1) Benedict’s Test • Note:
2) Fehling’s Test A first morning specimen does not always represent a
3) Robert Fermentation Test fasting specimen because glucose from an evening meal
4) Somogyi method may remain in the bladder overnight, and patients should
be advised to empty the bladder and collect the second
II. Test for Other Reducing Sugars
specimen.
A. Fructose
• Conditions:
1) Seliwannof’s Test
2) Borchardt’s Test Diabetes monitoring Diabetes mellitus /
3) Barfoed’s Test Hypoglycemia
B. Lactose (Normal urine excretion: 20 mg/24 hrs) • specimens are usually Urine glucose testing in
1) Rubner’s Test tested two hours after conjuction with blood
2) Ormsby’s Test meals samples during the
3) Mucic acid test • 2-hour postprandial course of glucose
4) Phenylhydrazine / Osazone Test specimen tolerance tests
5) Woehl’s Test
C. Pentose (xylose, arabinos and ribose) • Detection of ketone
1) Bial – Orcinol Test - valuable monitoring and management tool for patients
2) Tauber’s Test with type 1 diabetes mellitus.
3) Tollen’s Test
4) Cole’s Test Ketonuria
5) Woehlk’s Test
- early indicator of insulin deficiency
6) Aniline Test
7) Phenyhydrazine / Osazone Test
Ketoacidosis
III. Test for Ketone - can develop slowly and progressively as a result of
A. Reagent Strip test repeated insufficient insulin doses.
B. Nitroprusside Tablet Test for Ketones
(Acetest)
C. Other Specific Tests for Ketones
1) Acetone
a) Rothera’s Test (also for Diabetic
acid)
b) Lieben’s Iodoform test
c) Gunning’s Test (modification of
Lieben Test)
d) Frommer’s Test
e) Lange Test
f) Jackson-Taylor's Test
(Modification of Legal's Test)
g) Diffusion test for Acetone
h) Wallhausser's Test
2) Diabetic Acid
a) Gerhardt's Test
b) Lindemann's Test
c) Arnold's Test
3) Beta – Hydroxybutyric Acid
a) Hart's Test
b) Osterberg test
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• Reducing substances:
- Glucose
- Fructose
- Galactose
- Lactose
- Maltose
• Glucose oxidase impregnated on the reaction pad rapidly - Pentose
catalyzes the oxidation of glucose to form hydrogen - Ribose
- Arabinose
peroxide and gluconic acid.
• The hydrogen peroxide formed oxidizes the chromogen • Color change result: blue à green à orange
(potassium iodide) on the pad into iodide in the presence of • Benedict’s reagent composition:
peroxidase - copper sulfate
• Color change: blue to green to brown - sodium carbonate
- sodium citrate buffer
• Brand variation
• Result
Brand Sensitive
Result Interpretation
Chemstrip 40 mg/dL
(-) No change from the original
Multistix 75 – 125 md/dL
blue color
vChem 45 mg/dL
Trace Green
Note: - Without any
sensitivity of the reagent strip is affected by urine precipitate
temperature, pH and specific gravity.
+ Greenish Yellow
- With yellow
What decreases sensitivity of strip?
precipitate
o ⇧ specific gravity
++ Yellowish green
o ⇧ pH
- With yellow
o ⇩ Temperature
precipitate
o Ketonuria (with ketone concentration ≥40
+++ Yellowish orange
mg/dL)
- Orange precipitate
++++ Orange red
• Interferences:
- With brick red
Ascorbic acid precipitate
- oxidized by the hydrogen peroxide and will, therefore,
compete with the oxidation of potassium iodide,
resulting in the inhibition of the color formation.
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2ND SEMESTER – CLASS CODE
A.Y. 2022 – 2023 | MLS 321 ANALYSIS OF URINE AND BODY FLUIDS
UNIT 2: GLUCOSE, OTHER REDUCING SUGARS AND KETONES
GLUCOSE
Tests Method Procedure / Reagent Results and interpretations
Qualitative Tests
⭐⭐⭐⭐Fehling’s Test Reagent • Depends on the ability of glucose and other reducing sugars to
Fehling’s A Fehling’s B reduce alkaline copper sulfate reagent
Cupric sulfate in distilled water - Rochelle Salt - cupric hydroxide à cuprous hydroxide.
o Sodium potassium
tartrate + Yellow precipitate
o sodium hydroxide - Absence of yellow precipitate
o distilled water
Haine’s Test Reagent: • Depends on the ability of glucose and other reducing sugars to
- Copper sulfate reduce alkaline copper sulfate reagent
- NaOH - cupric hydroxide à cuprous hydroxide.
- Glycerol
- distilled water
• Positive result: Yellow to red precipitate
Procedure:
- Four (4) mL of Haine’s solution is boiled and 6 – 8 drops of urine is added while keeping the
reagent but not boiling.
Trommer Test Reagent: • Depends on the ability of glucose and other reducing sugars to
- 10% KOH reduce alkaline copper sulfate reagent
- 10% Copper sulfate - cupric hydroxide à cuprous hydroxide.
Positive Negative
Yellow red precipitate Absence of yellow precipitate
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⭐⭐⭐⭐Moore Heller’s Method Reagent: • based on the caramelization of sugars by strong alkali and
- 10% KOH heat.
Phenylhydrazine Test (Osazone Reagent: • based on the principle that each sugar forms a definite form
Test) - Phenylhydrazine chloride when it comes in contact with phenyl hydrazine and acetate
- Sodium acetate (crystals separate when sugar is present).
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• N.B. If less than 1 ml of urine is used up to the end point, make a 1:5 dilution with distilled water
and repeat the procedure.
- In the computation, multiply the number of mI used up to the end point by the dilution factor.
4. Record the amount of urine used up to the end point and compute using the following formula.
Fehling’s test 1 ml of Fehling’s solution is mixed with 4 ml of distilled water and then heated to boiling. Urine is
added drop by drop until the grayish white color is obtained.
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• Reagent:
- Resorcinol
- Concentrated HCl
Borchardt’s Test
• Hot HCl convert fructose à hydroxymethyl furfural
Positive:
- links with resorcinol to form a red colored compound • Red precipitate after heating the urine sample with HCl and
• Reagent: resorcinol
- potassium hydroxide • Yellow – colored acetic ether layer after reaction with KOH and
- acetic ether acetic ether
Barfoed’s Test • Fructose reduce: Cupric acetate à cupric hydroxide à cupric oxide Positive:
• Confirmatory test: • Red precipitate
- addition of 10 ml water and 1 ml of phosphomolybdic acid is advised
Confirmatory positive: (after phosphomolybdic acid addition)
- very dark, almost opaque, blackish hue/color
Reagents
- cupric acetate
- 38% acetic acid
- distilled water
B. Lactose Procedure / Reagents Results
Rubner’s Test⭐⭐⭐⭐ Reagents: • Brick red solution with cherry red or copper colored precipitate
- Lead acetate
- concentrated NH4OH • Glucose will give yellow solution with yellow precipitate
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KETONES
Test Procedure Results
A. Reagent Strip • based on the reaction of ketones with sodium nitroprusside (nitroferricyanide) impregnated in the
reagent pad.
• alkaline medium, acetoacetate reacts with nitroprusside to produce a color change from
beige to purple.
• Incorporation of glycine in the reagent pad enables detection of acetone.
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• does not react with beta-hydroxybutyrate. Red to purple ring at zone Purple ring
• False positive: of contact
- after a heavy meal (color persists for 30 seconds then disappear or fade within 3-4 minutes)
o In the same way, amorphous urates give a brown or orange color.
• Reagents:
- KOH
- 10 % alcoholic solution of salicylaldehyde
• Procedure
1) Glacial acetic acid and saturated solution of sodium nitroprusside is added with 5 ml of
urine.
2) 28 % ammonium hydroxide is overlayed
3) a purple/purplish red ring at the junction of the two liquids is considered as a positive result.
Legal’s test⭐⭐⭐⭐ • based on the decomposition of sodium nitroprusside or sodium ferrocyanide to sodium Purple or violet red color
ferrocyanide and ferric oxide in an alkaline solution.
1. Place a few ml of freshly voided urine sample in 16x 150 test tube.
2. Add enough NAOH or KOH to render the sample alkaline. Test with litmus paper after each
addition of alkali. • Alcohol and acetic aldehyde and diacetic acid gives the same
3. Add a few drops of fresh Sodium Nitroprusside solution. reaction
4. Add a few drops of concentrated acetic acid.
Lange Test • Glacial acetic acid and saturated solution of sodium nitroprusside is added with 5 ml of urine. Purple/purplish red at the junction of the two liquids
• 28 % ammonium hydroxide is overlayed
• a purple/purplish red ring at the junction of the two liquids is considered as a positive result
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Jackson – Taylor’s Test 1) Few drops of sodium nitroprusside are added in a few ml of urine. few purple-red color or permanganate colored ring at the point of
(Modification of Legal’s Test) 2) Ammonium sulfate is added followed by ammonium hydroxide. contact indicates the presence of acetone
Diffusion test for acetone • One (1) ml of Nessler’s reagent in a small petri dish is acidified with glacial acetic acid or HCl. cream colored precipitate
• Acetone in the urine being volatile diffuses and is fixed inside the covered petri dish which
could react with the Nessler reagent producing a cream- colored precipitate.
Wallhausser’s Test urine turns turbid with the addition of a drop of Scott-Wilson
Reagent (mercuric cyanide, silver nitrate, and NaOH)
• Scott – Wilson Reagent
- Mercuric cyanide
- Silver nitrate
- NaOH
B. DIACETIC ACID
Gerhardt’s Test • Ferric ions chelate with enol groups of diacetic acid Bordeaux red or wine-red complex
• FALSE POSITIVE - indicates presence of diacetic acid and or interfering
- aspirin (salicylates) substances like drugs
- phenol
- antipyrine
- sodium bicarbonate.
Lindemann’s Test Reagents:
- 30 % acetic acid Positive Negative
- iodine No change of color Reddish violet
- chloroform
o will become reddish violet if diacetic is not present. • Chloroform will become reddish violet if diacetic is not present
Arnold’s Test Reagent: Violet color
- (1) % sodium nitrate
- acetophenone solution
- ammonia
- concentrated HCl
C. Beta – hydroxybutyric acid
Hart’s Test
• Boiling breaks down diacetic acid to acetone and acetone is removed by evaporation. POSITIVE NEGATIVE
Addition of hydrogen peroxide oxidizes remaining acetone and diacetic acid. Tube with Tube without
hydrogen peroxide hydrogen peroxide
red ring at the point of No change in reaction
1) Place 5 ml of freshly voided urine sample in 16x150 test tube.
contact indicates presence
2) Add equal volume of water and a few drops of acetic acid.
of beta- hydroxybutyric
3) Boil the preparation ½ its original volume.
4) Dilute to 10 ml with distilled water. acid
5) Mix and divide the contents equally into two portions. Label them I and II.
6) To tube I, add 0.5 ml hydrogen peroxide. NO addition of hydrogen peroxide to tube II.
7) Warm both tubes gently and allow to cool.
8) Apply Legal's test to both tubes
9) Stand for few hours.
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