Page 37 - 2020 JSOM Winter

APPENDIX C: ABNORMALITIES DETECTION

Urine Dipstick: A dipstick—a thin, plastic stick with strips of mimic sepsis. This can occur in individuals who were not
chemicals on it—is placed in the urine to detect abnormalities. previously aware they are diabetic and is a life-threaten-
The chemical strips change color if certain substances are pres- ing condition, obtain telemedicine consult.
ent or if their levels are not normal. The color variation often ◆ Ketones. As with sugar, high levels of ketones detected
is indicative of how severe the abnormality is. Urine dipsticks in your urine could be a sign of diabetic ketoacidosis.
are another tool and indicator to measure a patient’s well- Ketones in urine may also be a sign of malnutrition and
being. Its values should be included in the “whole patient” protein-calorie deficit in the septic patient that should
approach to the medical evaluation. A dipstick test checks for: prompt consideration of starting caloric intake or en-
◆ Acidity (pH). The pH level indicates the amount of teral nutrition.
acid in urine. Abnormal pH levels may indicate a kid- ◆ Bilirubin. Bilirubin is a product of red blood cell break-
ney or urinary tract disorder or a potential systemic down or bile synthesized in the liver. Normally, bilirubin
infection—sepsis. is carried in the blood and passed into the liver, where
◆ Concentration. A measure of concentration, or specific it is conjugated and becomes part of bile. Bilirubin in
gravity, shows how concentrated particles are in your your urine may indicate liver damage, bile duct ob-
urine. A higher than normal concentration often is a re- struction, or hemolysis (e.g., distributed intravascular
sult of not drinking enough fluids. In the setting of sep- coagulopathy).
sis, it is a sign of clinically significant volume depletion. ◆ Evidence of infection. If either nitrites or leukocyte es-
◆ Protein. Low levels of protein in urine are normal. Small terase—a product of white blood cells—is detected in
increases in protein in urine usually are not a cause your urine, it may be a sign of a urinary tract infection
for concern, but larger amounts may indicate a kidney or systemic infection—sepsis.
problem. ◆ Blood. Blood in your urine requires additional testing—
◆ Sugar. Normally the amount of sugar (glucose) in urine it may be a sign of kidney damage, infection, kidney
is too low to be detected. Very high levels of glucose, or bladder stones, kidney or bladder cancer, or blood
especially when ketones are also elevated and pH de- disorders.
creased, can indicate diabetic ketoacidosis which may

APPENDIX D: MALARIA RAPID TEST AND MICROSCOPY

BinaxNOW ®
The BinaxNOW Malaria Test is a rapid ◆ Results appear in 15 minutes
®
and simple diagnostic test that can differ- ◆ Sensitivity: 99.7% (P.f.); 93.5% (P.v.)
entiate a deadly P. falciparum infection ◆ Specificity: 94.2% (P.f.); 99.8% (P.v.)
from a pan-malarial infection caused by
P. vivax, P. ovale, or P. malariae in three Reprinted with permission from Abbott Labs, July 2020.
simple steps using one reagent. Typically,
the limiting factor for mass-testing is the
amount of reagent on hand.

DIRECTIONS FOR BINAXNOW USE
Step 1 Step 2 Step 3 Step 4
Apply 15μL of blood to the Apply 2 drops of Reagent to the Apply 4 drops of Reagent to the When the blood sample reaches
bottom half of the purple pad. white pad immediately below pad located at the top of the left- the base of the white absorbent
where the blood was applied. hand side of the test card. pad at the top of the test strip,
close device and read after
15 minutes.

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