GLYCOSURIA a case study

1
GLYCOSURIAa case study

• Department Chemical Pathology
• Dr Elza Coetzee

2

• Diabetes /di??be?tez/ Gk, diabainein, to pass
  through, a clinical condition characterized by
  the excessive secretion of urine.
• mellitus /meli?t?s/ L, honeyed, sweet as honey

3
Mrs M - 34y32 w pregnant

• Referred from local clinic to local primary
  hospital
• Persistant glycosuria
• Fasting glucose values high

4
Mrs M - 34y32 w pregnant

• Referred from local clinic to local primary
  hospital
• Persistant glycosuria
• Fasting glucose values high

5
Mrs M - 34y32 w pregnant

• Referred from local clinic to local primary
  hospital
• Persistant glycosuria
• Fasting glucose values high

6
Findings at primary hospital

• Fasting glucose high
• Glycosuria
• PLAN
• Refer to Chem Path for oral glucose tolerance
  test for confirmation of Gestational Diabetes
  mellitus

7
Findings at primary hospital

• Fasting glucose high
• Glycosuria
• PLAN
• Refer to Chem Path for oral glucose tolerance
  test for confirmation of Gestational Diabetes
  mellitus

8
Findings at primary hospital

• Fasting glucose high
• Glycosuria
• PLAN
• Refer to Chem Path for oral glucose tolerance
  test for confirmation of Gestational Diabetes
  mellitus

9
OGTT

• Fasting plasma glucose
• 100mg anhydrous glucose taken orally (as advised
  by Tietz)
• 120min value 8.3 mmol/L
• 180min value 6.3 mmol/L

10
OGTT

• Fasting plasma glucose drawn
• 100mg anhydrous glucose taken orally (as advised
  by Tietz)
• 120min value 8.3 mmol/L
• 180min value 6.3 mmol/L

11
OGTT

• Fasting plasma glucose analyzed
• 100mg anhydrous glucose taken orally (as advised
  by Tietz)
• 120min value 8.3 mmol/L
• 180min value 6.3 mmol/L

12
OGTT

• Fasting plasma glucose 4.8 mmol/L
• 100mg anhydrous glucose taken orally (as advised
  by Tietz)
• 120min value 8.3 mmol/L
• 180min value 6.3 mmol/L

13
(No Transcript)
14
OGTT

• Fasting plasma glucose 4.8 mmol/L
• 100mg anhydrous glucose taken orally (as advised
  by Tietz)
• 120min value 8.3 mmol/L
• 180min value 6.3 mmol/L

15
OGTT

• Fasting plasma glucose 4.8 mmol/L
• 100mg anhydrous glucose taken orally (as advised
  by Tietz)
• 120min value 8.3 mmol/L
• 180min value 6.3 mmol/L

16
RESULTS

• At least two values should exceed reference
  values

17
RESULTS
18
RESULTS
19
RESULTS
20
RESULTS
21
Urinary Glucose(done on LX 20 by glucose oxidase
oxygen rate consumption method)Analytical range
0.2 33.3 mmol/L

• ORDAC high
• 110 dilution

22
Urinary Glucose(done on LX 20 by glucose oxidase
oxygen rate consumption method)Analytical range
0.2 33.3 mmol/L

• ORDAC high
• 110 dilution

23
Urinary Glucose(done on LX 20 by glucose oxidase
oxygen rate consumption method)Analytical range
0.2 33.3 mmol/L

• ORDAC high
• 110 dilution
• 180mmol/L!!!!

24
(No Transcript)
25
PITFALLS

• Causes of glycosuria
• WHO criteria for diagnosis of DM
• Indications for OGTT

26
Causes of Glycosuria

• Benign glycosuria
• Primary renal glycosuria___pregnancy
• Congenital renal glycosuria
• REDUCED RENAL GLUCOSE THRESHOLD

27
Causes of Glycosuria

• Benign glycosuria
• Primary renal glycosuria___pregnancy
• Congenital renal glycosuria
• Glycosuria with DM
• Serum glucose levels exceed normal renal
  threshold for glucose ( 9 11 mmol/L)

28
Causes of Glycosuria

• Benign glycosuria
• Primary renal glycosuria___pregnancy
• Congenital renal glycosuria
• Glycosuria with DM
• Tubular dysfunction
• Fanconi syndrome
• Rickets
• Wilsons disease
• Cystinosis

29
Causes of Glycosuria

• Benign glycosuria
• Primary renal glycosuria___pregnancy
• Congenital renal glycosuria
• Glycosuria with DM
• Tubular dysfunction
• Fanconi syndrome
• Rickets
• Wilsons disease
• Cystinosis

30
Causes of Glycosuria

• Benign glycosuria
• Primary renal glycosuria___pregnancy
• Congenital renal glycosuria
• Glycosuria with DM
• Tubular dysfunction
• Fanconi syndrome
• Rickets
• Wilsons disease
• Cystinosis

31
Causes of Glycosuria

• Benign glycosuria
• Primary renal glycosuria___pregnancy
• Congenital renal glycosuria
• Glycosuria with DM
• Tubular dysfunction
• Fanconi syndrome
• Rickets
• Wilsons disease
• Cystinosis

32
INTERFERENCES with METHODS
33
INTERFERENCES with METHODS
34
WHO criteria for diagnosis of Diabetes mellitus

• DM is defined by
• a fasting plasma glucose 7.0 mmol/L
• or
• a random plasma glucose 11.1 mmol/L
• or
• an abnormal oral glucose tolerance test.

35
WHO criteria for diagnosis of Diabetes mellitus

• DM is defined by
• a fasting plasma glucose 7.0 mmol/L
• or
• a random plasma glucose 11.1 mmol/L
• or
• an abnormal oral glucose tolerance test.

36
WHO criteria for diagnosis of Diabetes mellitus

• DM is defined by
• a fasting plasma glucose 7.0 mmol/L
• or
• a random plasma glucose 11.1 mmol/L
• or
• an abnormal oral glucose tolerance test
• The third measure (OGTT) is not recommended for
  routine clinical use

37
Indications for Oral Glucose Tolerance Test

• Fasting plasma glucose 6.1 6.9 mmol/L
• Random plasma glucose 7.0 11.0 mmol/L

38
Indications for Oral Glucose Tolerance Test

• Fasting plasma glucose 6.1 6.9 mmol/L
• Random plasma glucose 7.0 11.0 mmol/L

39

• Whole blood samples and capillary blood NOT
  satisfactory for diagnosis!!!!

40
Can the laboratory help in preventing these
mishaps?
41
Can the laboratory help in preventing these
mishaps?

• Training of medical students!!!
• Knowledge of WHO criteria
• Knowledge of glycosuria
• Knowledge of method interferences
• Acceptance of patient for OGTT only with
  accompanying fasting plasma glucose value

42
Can the laboratory help in preventing these
mishaps?

• Training of medical students!!!
• Knowledge of WHO criteria
• Knowledge of glycosuria
• Knowledge of method interferences
• Acceptance of patient for OGTT only with
  accompanying fasting plasma glucose value

43
REFERENCES

• Mosbys Medical, Nursing and Allied Health
  Dictionary, 5th edition
• Kaplan, L.A., Pesce, A.J., ClinicalChemistry,
  Theory, Analysis, Correlation, 4th edition
• Varley, H., Practical Clinical Biochemistry, 4th
  edition
• Thomas, L., Clinical Laboratory Diagnostics
• Tietz,NW., Clinical Guide to Laboratory Tests,
  3rd edition

44
(No Transcript)