Question

Case Study 4

A 14-day-old baby girl is admitted to the hospital with lethargy, diarrhea, vomiting, and difficulty in feeding. Physical examination reveals jaundice, an enlarged liver, and neurologic abnormalities (e.g., increased muscular tonus). No blood group incompatibility is found. She has lost 1.8 lb since birth. The infant is fitted with a collection bag to obtain a urine specimen. The collection takes place over several hours, and the baby's urine is sent to the laboratory for routine urinalysis

Urinalysis findings;

Color- Amber SG-1.025 RBC/hpf 0-2

Clarity- cloudy pH-8.0 WBC/hpf 0-2

Odor-Yellow foam noted Blood- Negative Csts/lpf- 0-2 hyaline 0-2 granular

Protein- Trace Epithelials- few SE cells/lpf

SSA 1+ Crystals/hpf- moderate triple phosphate

WBC- negative Bacteria/hpf-few

Nitrite negative

Glucose-negative

Clinitest 1000 mg/dl

ketones- negative

Bilirubin positive

ictotest- positive

urobilinogen-normal

Case Questions:

1. List any abnormal or discrepant urinalysis findings.

2. Which results may have been modified by the specimen collection conditions?

3. What substance is most likely causing the yellow coloration of the foam?

4. What is the most likely explanation for the discrepancy in the glucose screening results?

5. What is a possible diagnosis for this patient? How could this diagnosis be confirmed?

6. Does this patient have a urinary tract infection? Why or why not?

Answer 1