Urinalysis Diagnostic Case Study: Emily Winston

Here the case study is about Emily Winston is analysed and the topic of the paper is an urinalysis diagnostic essay example. The case study is about Emily Winston. First it is needed to define what is urinalysis. Urinalysis is the perusal of different levels of substances within a sample of urine obtained from an individual to assess the levels of various substances. This diagnostic method is often used prior to surgery, as a pre-emptive screening whilst you are pregnant or as part of a physical exam/ routine medical. I was provided with a urine sample from a patient named Emily Winston (34 y.o.). The urine sample was used to identify any abnormalities in the levels of the following substances:

• Leucocytes
• Nitrites
• Proteins
• pH
• Blood
• Specific gravity
• Ketone
• Glucose

These readings can be very useful if used in addition to other tests and assessments to confirm a specific diagnosis. Conjectures about the diagnosis in this instance could perhaps be gestational diabetes (GD). As this method of testing the urine is not the most reliable or effective, further tests may be required to confirm this diagnosis as occasionally false positive/ negative results can be given. Conditions relating to the irregular levels of leucocytes, nitrites, proteins, pH and ketones can be ruled off due to the regular results. The lack of protein indicates no signs of kidney disease, absence of leucocytes suggests UTI is not an issue, and lastly the absence of nitrites enables the disregard of any sort of bacterial infection.

Firstly, the Body Mass Index (BMI) was calculated using Emily’s height and weight of 163cm and 70kg respectively. It was calculated to check whether Emily fits in the healthy range of 18.5-24.9. The BMI was found to be 26.3 which falls in the overweight category, which could perhaps contribute to the tiredness she has been experiencing. A high BMI can have many associated risk factors: hypertension, High blood glucose, joint/back pain, feeling tired, breathlessness etc. Emily’s BMI provides support for my diagnosis as being overweight often results in your body having to work harder to do daily activities, thus the reason behind Emily feeling tired. Additionally, being overweight puts you at more risk of developing diabetes which links back to Emily possibly having GD.

Furthermore, Urine specific gravity is the measure of the concentration of various solutes within the urine. Higher urine concentration can be linked to glycosuria. Emily has a specific gravity of 1.015. Ideally, the specific gravity results should fall between 1.002 & 1.030. Specific gravity results >1.010 can indicate mild dehydration. The higher the specific gravity, the more dehydrated you are. The value present in Emily’s urine suggests that she is mildly dehydrated which is typically not dangerous for a pregnant mother as long as the intake of fluids is increased. However, there are side effects, one of which include feeling tired and lethargic. Dehydration can occur with increased ease if you have diabetes, suggesting that perhaps the dehydration may be linked to her GD.

In addition to the specific gravity, another abnormal result was found. This was the uncharacteristic presence of glucose in her urine. In this case the patient had very high levels (hyperglycaemia), thus signifying glycosuria. Normally, the kidney absorbs all blood sugars back however with glycosuria, the kidneys may not absorb back sufficient amounts before it passes out of the urine. This may happen if insulin is unable to completely transport blood sugar into your cells appropriately OR your body may not produce enough insulin to balance blood sugar levels resulting in excess sugar being passed through your urine. Glycosuria can also happen if you develop gestational diabetes during your pregnancy. Emily did not have diabetes prior to her pregnancy so the most rational explanation is that the high levels are due to GD.

After taking all the above mentioned factors into consideration, the most likely diagnosis for Emily Winston is indeed, gestational diabetes. GD is a common condition; it is defined as a carbohydrate intolerance of different severity. It develops during pregnancy typically between week 24-28 of the pregnancy and as we know, Emily is at 28 weeks. Developing this condition does not necessarily mean you were diabetic before, but it does increase your chances of developing type 2 diabetes in the future. This type of diabetes occurs when hormones from the baby’s placenta stop the insulin in the mother’s body from effectively regulating the blood glucose levels. It is divided into 2 classes: Class A1 can be controlled through diet alone whereas class A2 may need oral medications, e.g. oral hypoglycaemic agents or insulin injections. Symptoms include fatigue, blurred vision, excessive thirst and excessive need to urinate along with numerous others. Diabetes in general is a condition where there is an excessive amount of glucose (sugar) within the blood. Type 1 and type 2 diabetes are 2 different types, type 1 is a lifelong condition whereas type 2 can be managed with a healthy lifestyle and lastly gestational diabetes normally resolves after childbirth.

Pharmacists are in a pivotal position to remind pregnant women and those planning about the importance of early pregnancy care. As a pharmacist you may offer information regarding a healthy and well-balanced lifestyle, the long term and short term implications for her and her developing baby and how exercise and diet control could help. In this case, Emily should be advised to increase her intake of fluids (specifically water) in order to reduce dehydration, ultimately reducing tiredness. Furthermore, she should also be made aware of how effective blood glucose control throughout the duration of the pregnancy could decrease the risk of foetal macrosomia, neonatal hypoglycaemia, trauma during birth etc.

To sum up, according to the NICE guidelines, women diagnosed with gestational diabetes should be referred to a dietician. A dietician would most likely advise the patient to consume foods with a low glycaemic index (GI). Glycaemic index is a system whereby different food containing carbohydrates are rated, High GI foods are typically broken down very quickly by your body and cause a rapid increase in your blood glucose level. These foods should be avoided by having a diet plan to manage the condition.

References

• Urinalysis: Process, results and more, Healthline, Available from: https://www.healthline.com/health/urinalysis (Accessed on: 17/02/2019)
• BMI Calculator | Check Your Body Mass Index, patient.info, Available from: https://patient.info/doctor/bmi-calculator-calculator (Accessed on: 17/02/2019)
• Specific Gravity: Reference Range, Interpretation, Collection and Panels, Emedicine.medscape.com, Available from: https://emedicine.medscape.com/article/2090711-overview (Accessed on: 18/02/2019)
• Glycosuria: Symptoms, Causes, etc. Healthline, Available from: https://www.healthline.com/health/glycosuria (Accessed on: 24/02/2019)
• NICE - Gestational diabetes: risk assessment, testing, diagnosis and management (NICE 2019) (Accessed on: 24/02/2019)
• Everything You Need to Know About Gestational Diabetes, Healthline, Available from: https://www.healthline.com/health/gestational-diabetes#treatment (Accessed on: 28/02/2019)
• Gestational diabetes, Everest Pharmacy, Available from: https://www.everestpharmacy.co.uk/condition/gestational-diabetes/ (Accessed on: 28/02/2019)
• Urine Glucose Test: Purpose, Procedure, and Results, Healthline, Available from: https://www.healthline.com/health/glucose-test-urine#diabetes (Accessed on: 01/03/2019)
• What is the glycaemic index (GI)?, nhs.uk, Available from: https://www.nhs.uk/common-health-questions/food-and-diet/what-is-the-glycaemic-index-gi/ (Last reviewed: 2018) (Accessed on: 03/03/2019)
• Gestational Diabetes: What Patients Need to Know, Pharmacytimes.com