Alkaline Information and Courses from MediaLab, Inc.

Dipsticks measure pH using methyl red and bromthymol blue indicator dyes. The color change that occurs in this test area correlates with the urine's pH. Sensitivity to pH ranges from 5.0 (acid pH) to 9.0 (alkaline pH) on a urine reagent strip.

The urine specimen should be freshly voided. Urine is an ideal medium for the proliferation of bacteria due to the large amount of urea present. These bacteria metabolize urea, producing ammonia that increases the urine pH. If there is a delay before performance of the test, the sample should be refrigerated. This will: Prevent urease-producing organisms, such as Proteus and Pseudomonas, from converting urine urea to ammonia, which results in an increased pH. Prevent loss of CO2 which increases pH to the alkaline range.The "run-over" phenomenon may occur if excess urine remains on the strip. The protein area, adjacent to the pH area, contains an acid buffer which may "run-over" the pH portion resulting in an acid reading on a neutral or alkaline urine.

Testing for ketone bodies is based on a nitroprusside reaction. Acetoacetic acid reacts with sodium nitroferricyanide and glycerine in an alkaline medium to produce a violet-to-purple colored complex. The reagent strip method can detect as little as 5 mg/dL acetoacetic acid in urine. It does not react with acetone unless glycine is present or B-hydroxybutyric acid. Since these two compounds are derived from acetoacetic acid, their presence can be assumed if the test for ketones is positive. Ketones are reported either as negative, small, moderate or large amounts; or negative, 1+, 2+, 3+, or 4+. In some severe cases of ketosis, it may be necessary to perform tests on serial dilutions to provide more information on the quantity of ketones present.

Specific gravity measured with the reagent strip method correlates well with gravimetric measurement, and, unlike the gravimetric or refractometer methods, does not need to be corrected for glucose or protein. Cloudy/turbid urines do not need to be clarified before measuring specific gravity with the reagent strip method. It is the recommended method for determining specific gravity if a urine specimen contains x-ray contrast media or plasma expanders. Alkaline urine can affect the indicator system and lower the specific gravity result on the reagent pad. If the result is being read visually, it is recommended that .005 be added to the result when the pH is alkaline. Most dipstick readers, however, will automatically adjust the specific gravity reading for pH. A specific gravity reading higher than the reagent strip range would need to be measured by another method, and may require dilution.

Chemiluminescent assays use antibodies that are conjugated to enzymes, such as peroxidase or alkaline phosphatase. These enzymes, mixed with chemiluminescent substrates, produce light in the visible spectrum. A direct relationship exists between the amount of drug that is present in the sample and the light units that are produced and measured by the luminometer in the instrument. Assays that use chemiluminescence are more sensitive than immunoassays that rely on the generation of a colored product.

Consists of a basic metabolic panel, plus:Albumin (Alb) and Bilirubin (Bili) Alkaline Phosphatase (Alk Phos) Total protein (TP) Alanine aminotransferase (ALT) Aspartate aminotransferase (AST)

Urine sediment may also contain white blood cells (WBCs). Most of the WBCs in urine are segmented neutrophils. Since it is possible that lymphocytes, monocytes, and/or eosinophils may be present, the cells in urine can be stained if it is necessary to differentiate them. The segmented neutrophil just above center of the image to the right shows a distinct nucleus. When viewing urinary sediment under the microscope, the fine focus adjustment must be used to identify white blood cells. White blood cells swell in dilute alkaline urine and the cytoplasmic granules exhibit brownian movement resulting in “glitter cells.” These cells lyse rapidly. “Glitter cells” are most easily seen when viewed under phase-contrast microscopy.

Amorphous urates appear as dark or yellow red granules while phosphates are white or colorless. The pH of the urine determines the type of amorphous crystals present. They may be urates in acid urine or phosphates in alkaline urine.

The term leukemoid reaction is used to describe peripheral white blood cells that on the stained blood smear may have some resemblances to leukemia cells. Quantatively in a leukemoid reaction, the neutrophil count is >50,000 cumm with more immature cells, particularly myelocytes, than are usually present in toxic left shift syndromes. The presence of immature cells in a leukemoid reaction awakens thoughts of leukemia. Great care must be taken to make a distinct differentiation between aberrant white blood cell proliferations and a benign but exaggerated granulocytic proliferative response. Our material is from a 1-month-old girl with Down's syndrome. Her total white blood count was 37,000/mm3 interpreted as leukocytosis with left shift. Leukocytosis with a left shift, and leukemoid reactions with high alkaline phosphatase are conditions to be mindful of in patients with Down's syndrome. The alkaline phosphatase score is high in leukemoid reactions, low in granulocytic leukemia.