What is the interpretation of following urine dipstick?

Question

I saw patient 26 y/o M with c/o of flank pain and frequent urination 1-4days.

Asthma? no, Temp 97.7, HR 86, RR 16, BP 127/79, Ht 69", Wt 220, BMI 32.48, Peak Flow n/a, O2 Sat 97% room air, Pain Scale 4-5, LMP: n/a, Smoke? NO, Drugs? NO, Alcohol? SOCIAL

Urine Dipstick

Specific Gravity=1.005

Blood= Trace

Bili=small

pH=7.4

When I saw these results I thought maybe pt has r/o obstruction secondary to the stones or work pt up for diabetes insipidus for complaint of increase urination with low specific gravity

pt saw provider repeat labs order which is definitely important

Dr ordered

Chem

CBC

Urinalysis

lipid panel

RPR

Pt given naprosyn for pain managment and f/u in 4weeks with PCP.

I was just curious what another provider would have done in this case. Is my interpretation way off. I am thinking along the correct lines with urine dipstick or did not totally miss it. Is the provider approach to conservative for this c/o or totally appropriate. I want to learn thought I ask.

Also if I am right and you suspect diabetes inspidus with b/c low specific gravity are there not other test that you can order. ADH ???

Curiosity is killing me and I need to know. I appreciate your feed back.

Answer 1

The V/S are all WNL.  Pain is moderate.  SpO2 is good.  As far as the UA, the spec. grav. is normal, the range is 1.005-1.030.  Less than 1.005, suspect diabetes insipidus but could just as well be overhydration or potassium deficit.  Why would you suspect diabetes insipidus with a normal spec. grav. and not describe the color and clarity of the urine?  I'd be looking for clear, colorless urine.  What was the odor, was the urine foamy?  pH is normal.  What about protein and WBCs??  Wasn't a micro run?  No urine glucose?

DI is a pituitary issue and doesn't present with flank pain.  You may end up ruling it out.  The orders for the BMP, CBC, repeat UA (to include both macro & micro), and lipids are appropriate.  Why the RPR?  I see no c/o sxs of syphilis.  I would have added a urine C/S.  There isn't enough data to support a diagnosis yet.  I would have follow up post labs, not in 4 weeks.  Patient could be seen in one week.  C/S takes 3 days.  All other labs take one.

Possible UTI until more is known.  Pt. is obese with BMI of 32.5 (round it up) and I would keep that in mind when making a diagnosis.  Remember that the word means "complete knowledge".  Good luck, very interesting.