CHEMICAL EXAMINATION OF URINE (KETONE BODIES)

(40) (ketones) (acetone (2%),

(acetoacetic acid (20%)) (β- hydroxybutyrate)

(β- hydroxybutyrate (78%)) (carbon dioxide) (water) (available carbohydrate) (compromised) (starvation diet)

KETONE BODIES

● Reading time for ketones using the Multistix Reagent

Strip is (_____) seconds.

● The term “(_________)” represents three intermediate

products of fat metabolism, namely, (________, ________), and (____________).

● Normally, measurable amounts of ketones do not

appear in the urine, because all the metabolized fat is

completely broken down into (__________) and

(_____).

● However, when the use of (____________) as

the major source of energy becomes (_______),

body stores of fat must be metabolized to supply energy.

Ketones are then detected in urine.

● Ketones is also one of the analytes that tests positive

when the patient is undergoing (_____________).

(Fasting or starvation) (Patients with Diabetes Mellitus Type 1) (Acetone (2%)) (Acetoacetic acid (20%)) (Beta hydroxybutyrate or Beta hydroxybutyric

acid (78%)) () () () () ()

CLINICAL SIGNIFICANCE

● Ketone bodies are formed during fatty acid metabolism.

o (______________)

o (_____________________)

● Three ketone bodies:

o (_______)

o (___________)

o (______________/___________)

DIABETES MELLITUS TYPE 1

● The insulin is insufficient or not functioning.

● Instead of utilizing the carbohydrates, the body would

utilize the stored fats in the unavailability of the

carbohydrates as a source of energy.

(Sodium Nitroprusside (Nitroferricyanide) reaction) (acetoacetate) (acetone) (purple color) (glycine) (Midstream, clean catch urine) (● Test tubes

● Reagent strips

● Test tube rack) (Phthalein dyes) (red urine) (Levodopa) (free

sulfhydryl groups) (phenolsulfonphthalein

and bromsulphalein) (levodopa and medications) (sulfhydryl) (mercaptoethane

sulfonate sodium

(MESNA)) (captopril) (improperly timed readings) (acetone) (acetoacetic) (bacteria) (40) (○ Negative

○ Trace

○ Small

○ Moderate

○ Large) () ()

REAGENT STRIP METHOD

Principle	● (______________________). ● In the presence of the ketone bodies, in the form of (_________) or sometimes (________), it combines with the (1) (________________) (reagent) that is impregnated onto the urinary reagent strip pad for ketones. In an alkaline medium, it will produce a (_______). ● Only detects (2) (_________). ○ Can detect (3) (________) if (______) is added. ● In this reaction, acetoacetic acid in an alkaline medium reacts with
Specimen
Equipment and Materials

Reaction Interference	False Positive (+) ● (_________) ● Highly pigmented (______) ● (________) ● Medications containing (_________) False Negative (-) ● Improperly preserved specimens ○ Specimens obtained following diagnostic procedures using the dyes (__________&_________) may produce an interfering red color in the alkaline test medium, as does highly pigmented red urine. ○ Large amounts of (______&______) containing (________) groups, including (_______________) and (_______), may produce atypical color reactions. ○ Reactions with interfering substances frequently fade on standing, whereas color development from acetoacetic acid increases, resulting in false-positive results from (___________). ○ Falsely decreased values due to the volatilization of (______) and the breakdown of (_________) acid by (________) are seen in improperly preserved specimens.
Reading time	● 40 Seconds (Multistix Reagent Strip)
Reporting	● Follow qualitative reporting:

(sodium ferrocyanide (Na4Fe(CN)6)) (sodium nitrite (NaNO2))

(ferric hydroxide (Fe(OH)3)) (ammonium sulfate) (rose to purple)

(Midstream, clean catch) (●

Test tubes

● Rothera’

s reagent/Legal’

s reagent

● Conc. NH4OH ● Test tube rack)

(Purple Colored Ring) (No formation of

purple colored ring) (15- 20 times) (Nitroprusside rate test)

(Not routinely performed) ()

ROTHERA’S TEST

Principle	● This test is based on nitroprusside reaction. Sodium nitrogen is decomposed to (____________), (__________), and (_____________) in a buffered (____________) solution producing a (____________) color in the presence of acetone and acetoacetic acid.
Specimen	(____________, _________)
Equipment and Materials

Results	● Positive Result: (________) ● Negative Result: (________)
Quality Control	● Check Rothera’ s Reagent and reagent strips by running it with a positive and negative control.
Notes	● (_________) more sensitive to the ketones acetoacetate and acetone. ● (______________). ● (_______________) / no longer performed in the laboratory.