URINE AND

OTHER BODY FLUIDS

PREPARED BY:
LAWRENCE G. GAMBOA, RMT
 URINE
● Laboratory testing of urine generally falls ino 3 categories:

- chemical
- bacteriologic
- microscopic examination

● Type of urine collection:

- random
- clean-catch
- timed
- 24 hrs
- catheterized
 URINE
• RANDOM URINE
- collected at any time.
- a first-morning-voided aliquot is optimal
for constituent concentration; most
concentrated and has lower pH caused by
decreased respiration during sleep.
 URINE
● CLEAN-CATCH/MIDSTREAM
- most desirable for bacteriologic examinations.
- proper collection requires the px first clean
the external genitalia with an antiseptic wipe;
the px next begins urination; stop midstream,
and discards this 1st portion of the urine, then
collects the remaining urine in a sterile
container.
 URINE
● TIMED URINE SPECIMEN
- obtained at designated intervals, starting
from “time zero”.
- collection time is noted on each
subsequent container.
 URINE
● 24 HOUR URINE SPECIMEN
- are most difficult to obtain and require patient
cooperation.
- incomplete collection is the most frequent
problem.
- preferred container is unbreakable, measures 4L
(approx), is plastic, chemically clean with correct
preservative added.
- commonly, urine is collected from 2-4pm, when a
quantification of urobilinogen is requested.
 CHANGES IN URINE WITH DELAYED TESTING
RESULT REASON

CHANGES IN COLOR Breakdown or alteration of chromogen or other

urine constituent (e.g., hemoglobin, melanin,
homogentisic acid, porphyrins)

CHANGES IN ODOR bacterial growth, decomposition

INCREASE TURBIDITY increased bacteria, crystal formation,

precipitation of amorphous material

FALSELY LOW pH glucose converted to acids and alcohols by

bacteria producing ammonia. Carbon dioxide lost

FALSELY ELEVATED pH breakdown of urea by bacteria, forming ammonia

FALSE NEGATIVE GLUCOSE utilization by bacteria - glycolysis

FALSE NEGATIVE KETONE volatilization of acetone; breakdown of

acetoacetate by bacteria.
 CHANGES IN URINE WITH DELAYED TESTING

RESULT REASON

FALSE NEGATIVE BILIRUBIN Destroyed by light; oxidation to biliverdin

FALSE NEGATIVE UROBILINOGEN destroyed by light

FALSE POSITIVE NITRITE nitrite produced by bacteria after specimen

is voided

FALSE NEGATIVE NITRITE nitrite converts to nitrogen and evaporates

DISINTEGRATION OF CELLS/CASTS Unstable environment, esp. in alkaline

urine, hypotonic urine or both

INC. BACTERIURIA Bacteria multiply in specimen before

analysis
 SPECIAL URINE COLLECTION
TECHNIQUES
- Catheterization of the urethra and bladder may cause
infection but is necessary in some patients (e.g., for urine
collection when patients are unable to void or control
micturition)
- urethral catheter can also be inserted via a cytoscope into
the ureter
- bladder urine is collected first, followed by bladder washing
- urethral urine specimen are useful in differentiating bladder
from kidney infection, or for differential uretral analysis.
- first morning urine is optimal for cytologic examination.
 OTHER BODY FLUIDS: CSF
- done by lumbar puncture (LP) for lab evaluation to
establish a diagnosis of infection (bacterial, fungal,
mycobacterial or amebic meningitis), malignancies,
subarachnoid hemorrhage, multiple sclerosis, or
demyelinating disorders.
- common site for LP is bet. the 3rd and 4th lumbar
vertebrae.
- before CSF is collected, the pressure should be between 90
and 180 mm Hg; measured by allowing fluid to rise in a
sterile, graduated manometer.
 OTHER BODY FLUIDS:
SYNOVIAL FLUID
- found in the joint cavities is an ultrafiltrate of plasma that is passed
through fenestrations of the subsynovial capillary endothelium into
the synovial cavity.
- differs from other fluid because it contains hyaluronic acid (mucin)
and may contain crystals.
- collected by ARTHROCENTESIS.
- the sterile tube is sent to microbiology, the anticoagulated tube is
sent to hematology, and the red-top tube, after centrifugation, is
used for chemical analysis.
 PLEURAL FLUID, PERICARDIAL &
PERITONEAL FLUID
PLEURAL FLUID
- Ultrafiltrate of the blood plasma.
- formed continuously in the pleural cavity.
- acts as a natural lubricant for contraction and expansion of the lungs during
respiration.
- it is reabsorbed by the lymphatics and the venules in the pleura.
- THORACENTESIS: surgical procedure to drain fluid (effusion) from the
thoracic cavity and is helpful in diagnosing inflammation or neoplastic
disease in the lung or pleura.
 PLEURAL, PERICARDIAL &
PERITONEAL FLUID
PERICARDIAL FLUID:
- PERICARDIOCENTESIS refer to the collection of fluid from the
pericardium (effusion)

PERITONEAL FLUID:
- PERITONEOCENTESIS refer to the collection of fluid from the
peritoneal cavities (ascites)
THE END..