Urinalysis

Introduction
Public summary: 

Practise diagnosing patients using this simple bedside test - use the dipsticks to analyse "urine" from our patients.

Useful information
Kit List: 

Urine dipsticks
Paper towel
Bin bag
Large bottles
20ml universal containers
Laminated speech bubbles
Yellow food colouring
Sugar
Powdered milk
Meat blood (lamb or poultry)
Water
Nitrile gloves

Packing Away: 

Make sure to tip all ‘urine’ down the sink – DO NOT pack it away in the box!

Explanation
Explanation: 

In a nutshell:
Use urinalysis dipsticks to test the content of artificial urine. Talk about some of the medical conditions that could cause these results (diabetes, urinary tract infection, kidney stones)

How to set up the experiment:
Make up bottles of each urine type:
Normal – water. You can add some yellow food colouring if desired
Diabetes – add some sugar (plus yellow food colouring if desired – only a small drop is required for a full 500ml bottle)
Infection – add a small amount of powdered milk (plus yellow food colouring if desired)
Kidney stones – add a few drops of blood from some fresh meat (e.g. lamb mince)
Pour a sample of each urine type into 20ml containers.
Kids can dip a urinalysis stick into one (or several) samples, place the stick on some paper towel and read off the result against the side of the bottle. You can play a diagnostic matching game, matching the urine samples to the patient’s symptoms and the doctor’s explanation.

Background information:
Urinalysis is a quick, simple and cheap test often used in GP surgeries – many children may have had to provide a wee sample at some point. The results of a dipstick may be all that is required to confirm a diagnosis, or further tests may be carried out (e.g. fasting blood glucose for diabetes, microscopy for infection or imaging for renal stones).
These urine dipsticks test a variety of parameters in addition to the protein, glucose and blood examined here, e.g. bilirubin, a breakdown product of haemoglobin, the presence of which might suggest hepatitis, and urine specific gravity (likely to be abnormal here as we’re just testing water), which can give a measure of dehydration.

Urinary Tract Infections (UTIs) (from Wikipedia)
A urinary tract infection (UTI) is an infection that affects part of the urinary tract. When it affects the lower urinary tract it is known as a simple cystitis (a bladder infection) and when it affects the upper urinary tract it is known as pyelonephritis (a kidney infection). Symptoms from a lower urinary tract include painful urination and either frequent urination or urge to urinate (or both), while those of pyelonephritis include fever and flank pain in addition to the symptoms of a lower UTI. In the elderly and the very young, symptoms may be vague or non specific. The main causal agent of both types is Escherichia coli, however other bacteria, viruses or fungi may rarely be the cause.
Urinary tract infections occur more commonly in women than men, with half of women having at least one infection at some point in their lives. Recurrences are common. Risk factors include female anatomy, sexual intercourse and family history. Pyelonephritis, if it occurs, usually follows a bladder infection but may also result from a blood borne infection. Diagnosis in young healthy women can be based on symptoms alone. In those with vague symptoms, diagnosis can be difficult because bacteria may be present without there being an infection. In complicated cases or if treatment has failed, a urine culture may be useful. In those with frequent infections, low dose antibiotics may be taken as a preventative measure.
In uncomplicated cases, urinary tract infections are easily treated with a short course of antibiotics, although resistance to many of the antibiotics used to treat this condition is increasing. In complicated cases, longer course or intravenous antibiotics may be needed, and if symptoms have not improved in two or three days, further diagnostic testing is needed. In women, urinary tract infections are the most common form of bacterial infection with 10% developing urinary tract infections yearly.

Kidney Stones
A kidney stone, also known as a renal calculus is a solid concretion or crystal aggregation formed in the kidneys from dietary minerals in the urine.
Urinary stones are typically classified by their location in the kidney (nephrolithiasis), ureter (ureterolithiasis), or bladder (cystolithiasis), or by their chemical composition (calcium-containing, struvite, uric acid, or other compounds). About 80% of those with kidney stones are men. Men most commonly experience their first episode between 20-30 years of age, while for women the age at first presentation is somewhat later.

Kidney stones typically leave the body by passage in the urine stream, and many stones are formed and passed without causing symptoms. If stones grow to sufficient size (usually at least 3 millimeters (0.12 in)) they can cause obstruction of the ureter. Ureteral obstruction causes postrenal azotemia and hydronephrosis (distension and dilation of the renal pelvis and calyces), as well as spasm of the ureter. This leads to pain, most commonly felt in the flank (the area between the ribs and hip), lower abdomen, and groin (a condition called renal colic). Renal colic can be associated with nausea, vomiting, fever, blood in the urine, pus in the urine, and painful urination. Renal colic typically comes in waves lasting 20 to 60 minutes, beginning in the flank or lower back and often radiating to the groin or genitals. The diagnosis of kidney stones is made on the basis of information obtained from the history, physical examination, urinalysis, and radiographic studies. Ultrasound examination and blood tests may also aid in the diagnosis.
When a stone causes no symptoms, watchful waiting is a valid option. For symptomatic stones, pain control is usually the first measure, using medications such as nonsteroidal anti-inflammatory drugs (such as ibuprofen). More severe cases may require surgical intervention. For example, some stones can be shattered into smaller fragments using extracorporeal shock wave lithotripsy. Some cases require more invasive forms of surgery. Examples of these are cystoscopic procedures such as laser lithotripsy or percutaneous techniques such as percutaneous nephrolithotomy. Sometimes, a tube (ureteral stent) may be placed in the ureter to bypass the obstruction and alleviate the symptoms, as well as to prevent ureteral stricture after ureteroscopic stone removal.

Diabetes Mellitus
Diabetes mellitus, or simply diabetes, is a group of metabolic diseases in which a person has high blood sugar, either because the pancreas does not produce enough insulin, or because cells do not respond to the insulin that is produced.[2] This high blood sugar produces the classical symptoms of polyuria (frequent urination), polydipsia (increased thirst) and polyphagia (increased hunger). The cause of the polyuria is simply osmotic diuresis – the glucose content of the blood is so high that it cannot all be reabsorbed by the renal tubules and thus glucose is excreted in the urine. This increases osmotic pressure in the tubule, causing retention of water and thus high volumes of urine.
There are three main types of diabetes mellitus (DM).
Type 1 DM results from the body's failure to produce insulin, and currently requires the person to inject insulin or wear an insulin pump. This form was previously referred to as "insulin-dependent diabetes mellitus" (IDDM) or "juvenile diabetes".
Type 2 DM results from insulin resistance, a condition in which cells fail to use insulin properly, sometimes combined with an absolute insulin deficiency. This form was previously referred to as non insulin-dependent diabetes mellitus (NIDDM) or "adult-onset diabetes".
The third main form, gestational diabetes occurs when pregnant women without a previous diagnosis of diabetes develop a high blood glucose level. It may precede development of type 2 DM.

Risk Assessment
Date risk assesment last checked: 
Fri, 25/01/2019
Risk assesment checked by: 
Matt Worssam
Date risk assesment double checked: 
Wed, 30/01/2019
Risk assesment double-checked by: 
Helen G
Risk Assessment: 

Using urinalysis dipsticks to test artificial urine.

Hazard Risk Likelihood Severity Overall Mitigation Likelihood Severity Overall
Spillages Slip hazard. 3 2 6 All spills should be cleared up immediately. Call a first aider in case of accident. 2 2 4
Powdered milk Allergen hazard from powdered milk. 2 3 6 Do not allow children to dip fingers in artificial urine, encourage use of gloves, encourage children to wash their hands afterwards. Alert parents to presence of milk if you are concerned that a child has dipped their fingers in the solution.
Call a first aider in the event of reaction.
1 3 3
Raw meat Risk of bacterial contamination from uncooked meat blood. 3 3 9 Do not allow children to dip fingers in artificial urine, encourage use of gloves, encourage children to wash their hands afterwards. Alert parents to presence of raw meat if you are concerned that a child has dipped their fingers in the solution. 1 3 3
Samples Feeling faint/fainting at sight of experiment. 2 3 6 Be aware that a small percentage of people may feel uneasy or unwell. Stop if someone looks unwell/goes pale. Have a chair nearby light-headed-feeling people, and ask anyone who feels faint to sit down. Call first aider in case of injury. 2 2 4
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