Every so often, I get a question from a reader, listener, or viewer about what it means when they have their urine checked with a commercially-available “dipstick.” A good amount of information can be gleaned from this simple tool, which can test from one to fourteen “reagent” parameters that relate to health. Having a supply of test strips might, therefore, be helpful for the survival medic.
Dipsticks are little plastic strips with colored squares that react when dipped in urine. Each square measures a different aspect of the chemical composition in the sample. The dipstick container has a color chart which indicates the level of the parameter tested. The results can suggest infection, diabetes, kidney issues, and more.
Urine dipsticks are easy to use and read. You dip the strip in a urine sample and compare the color change of the squares to the colored chart to get a reading. Some color changes occur after a period of time, so the chart may say 30 or 60 seconds before the result of a particular square is considered accurate.
The fourteen parameters tested in the most extensive dipsticks available are
Leukocytes (bladder, kidney infections)
Nitrites (bladder, kidney infections)
Urobilinogen (liver health)
Protein (kidney health)
PH: (acidity or alkalinity)
Blood: (kidney stones, infection)
Specific Gravity (concentration of urine, dehydration)
Ascorbate (Vitamin C level)
Ketones (diabetes, starvation)
Microalbumin (kidney damage)
Creatinine (kidney health)
Calcium (kdney, heart, thyroid health)
LEUKOCYTES: Also known as white blood cells, these entities’ job is to fight infection. An excessive amount could be a sign of an ongoing infection, usually in the bladder or kidney.
NITRITES: Normal urine contains nitrates. If bacteria is present in the urinary tract, nitrates turn into nitrItes, a sign of a urinary tract infections.
UROBILINOGEN: There’s a substance in your liver called bilirubin. It helps to break down old red blood cells. Normal urine has some of the metabolic product of bilirubin, called “urobilinogen.” If there is no urobilinogen in the urine, it could mean your liver is malfunctioning.
BILIRUBIN: If bilirubin isn’t converted into urobilinogen, it could register in the urine and indicate liver damage, disease, or hepatitis.
KETONES: If your body is burning fat for energy, such as in poorly-controlled diabetes or in a state of starvation, substances called ketones appear in your urine. People on keto diets may also have ketones.
CREATININE: Creatinine is a breakdown product of a similarly named compound called creatine in muscles. The body eliminates creatinine through the kidneys. High levels in the urine can indicate diabetes, kidney damage, or are even seen in those with large muscle mass.
BLOOD: Blood in the urine is usually microscopic and not visible with the naked eye. Kidney stones, bladder infections, and various other problems may cause blood to be present in the urine reading.
PROTEIN: The presence of protein, or albumin, can be a sign of kidney damage caused by hypertension, congestive heart failure, tumors, or other conditions. Some situations where protein is noted that aren’t disease-related, however, include pregnancy or extreme muscle exertion.
MICROALBUMIN: Very small levels of protein (albumin) can be identified via dipstick. When microalbumin is noted on the strip, it may represent a warning sign of early chronic kidney disease. It’s considered more specific for kidney issues that just protein in the urine.
GLUCOSE: The presence of glucose on urine dipstick is suggestive of diabetes. Normally, non-diabetics will have no glucose present on the test strip. The result, however, varies with the person and, may be elevated soon after a meal. Blood tests are considered much more accurate, but when seen in the urine, glucose is very likely to also be high in the blood.
CALCIUM: Too much or too little calcium in the urine may indicate kidney disease or stones. It also may be seen in much rarer conditions such as parathyroid gland dysfunction or sarcoidosis. Sometimes, a high calcium may be a result of high vitamin D levels (which is good!) Like all tests, it’s important to take the patient’s history to look for symptoms.
ASCORBATE: Ascorbic acid is vitamin C and found in various foods and supplements. When the urine reveals high levels, some of the other parameters may not be accurate, such as glucose, nitrite, or bilirubin.
pH: Urine may be neutral (pH=7.0) or it may be acidic or alkaline. Normal urine is a little acidic, about 6.0 pH. It can vary, however, dependent on diet, time of day, and level of hydration. Examples of more acidic foods are grains, sodas, fish, sugary foods, and foods that are high in protein. Foods with high alkaline levels include vegetables, nuts, and most fruits.
Various medical conditions can also affect urine pH. Low pH can be seen with:
A high pH level could be a sign of:
Respiratory alkalosis (happens when you’re breathing too fast)
Certain types of GI obstruction
Urinary tract infection
SPECIFIC GRAVITY: The specific gravity tells you how concentrated the urine is. Normal specific gravity falls between 1.005 and 1.030. The higher the value, the more dehydrated you are. Constantly very low values may indicate a form of diabetes called diabetes insipidus or certain types of kidney damage. Constantly high values may suggest severe dehydration, kidney damage, liver or heart failure, or even shock. Renal failure is noted to have a specific gravity fixed at about 1.010 regardless of hydration status.
It should be noted that general appearance of the urine to the naked eye can also give you some information. Urine may range in color from light yellow to amber, but it should be clear; cloudy urine is a sign of infection. The darker the urine and smaller the output, the more likely the patient is dehydrated and needs fluids. Some drugs used to treat painful urination, like Pyridium (phenazopyridine), will change the urine’s color to orange. This color change is harmless. The odor is important, as well: A fruity odor is a sign of ketones and is often seen in poorly-controlled diabetes. Alternatively, it can be seen in someone who is not taking in enough food or is fasting.
The result of one urine test strip evaluation doesn’t necessarily make the diagnosis. It’s useful to perform multiple readings at different times. The specific gravity, for example, of urine will vary within a short time if someone is given a lot of fluids or is deprived of fluids.
The urine can identify a number of medical problems and test strips are a helpful addition to the medic’s storage. They don’t take the place of knowing the signs and symptoms of an illness, however. Use all the tools in the medical woodshed and you’ll be effective in your role as survival caregiver.
Joe Alton MD
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