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Human and animal diabetics both use ketostix or ketodiastix. These are reagent indicator strips that test urine for only ketone (ketostix) or for both ketones and glucose (ketodiastix). These links show examples of Ketostix<ref> [http://hocks.com/hocks_com_on_line_pharmacy/2701878.html Hocks.com Website: Ketostix]</ref> and Ketodiastix<ref>[http://hocks.com/hocks_com_on_line_pharmacy/2463008.html Hocks.com Website: Ketodiastix]</ref>. |
Human and animal diabetics both use ketostix or ketodiastix. These are reagent indicator strips that test urine for only ketone (ketostix) or for both ketones and glucose (ketodiastix). These links show examples of Ketostix<ref> [http://hocks.com/hocks_com_on_line_pharmacy/2701878.html Hocks.com Website: Ketostix]</ref> and Ketodiastix<ref>[http://hocks.com/hocks_com_on_line_pharmacy/2463008.html Hocks.com Website: Ketodiastix]</ref>. |
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− | These stix are available at any brick-and-mortar or Internet pharmacy that sells human diabetic supplies. Stix do expire, so check the unopened expiration date when you buy them and record the date you open them. Keep the bottle tightly closed when not in use; prolonged exposure to air can produce false negative urine ketone test results<ref>[http://www. |
+ | These stix are available at any brick-and-mortar or Internet pharmacy that sells human diabetic supplies. Stix do expire, so check the unopened expiration date when you buy them and record the date you open them. Keep the bottle tightly closed when not in use; prolonged exposure to air can produce false negative urine ketone test results<ref>[http://www.abbottdiabetescare.com/adc_dotcom/url/content/en_US/20.10.30:30/general_content/General_Content_0000068.htm Precision Xtra-Blood Ketone Test Strips]</ref>. |
− | If the foil-wrapped Ketostix, rather than the ones in vials are purchased, you may find it less wasteful. After the bottle is opened, the remaining unused strips have only a 6 months' life. By using the foil-wrapped ones, you can extend the "life" of your purchase. The singly-wrapped ones can have a unopened expiration date of up to two years. You are then only using what you need when you need it, having the rest still sealed and potent until the indicated expiration date<ref> [http://www.uchsc.edu/misc/diabetes/ud05.pdf Understanding Diabetes-Ketone Testing]</ref>. |
+ | If the foil-wrapped Ketostix, rather than the ones in vials are purchased, you may find it less wasteful. After the bottle is opened, the remaining unused strips have only a 6 months' life. By using the foil-wrapped ones, you can extend the "life" of your purchase. The singly-wrapped ones can have a unopened expiration date of up to two years. You are then only using what you need when you need it, having the rest still sealed and potent until the indicated expiration date<ref> [http://www.uchsc.edu/misc/diabetes/books/ud11/ud05.pdf Understanding Diabetes-Ketone Testing]</ref>. |
==Testing reasons== |
==Testing reasons== |
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==Urine Glucose Testing== |
==Urine Glucose Testing== |
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− | Some reasons for preferring testing glucose levels by using blood over urine testing is that the urine used in testing may have been in the bladder for hours. Because of this, it may not be a reliable indicator of what systemic glucose levels are at the time of testing<ref>[http://www.peteducation.com/article.cfm?cls=2&cat=1579&articleid=257 Pet Education.com-Drs. Foster & Smith-Blood Glucose Curves]</ref>. What's seen when testing urine for glucose is an average of what the level of glucose has been over a period of about 5-8 hours (the time period from last urination)<ref>[http://www.noahcompendium.co.uk/ |
+ | Some reasons for preferring testing glucose levels by using blood over urine testing is that the urine used in testing may have been in the bladder for hours. Because of this, it may not be a reliable indicator of what systemic glucose levels are at the time of testing<ref>[http://www.peteducation.com/article.cfm?cls=2&cat=1579&articleid=257 Pet Education.com-Drs. Foster & Smith-Blood Glucose Curves]</ref>. What's seen when testing urine for glucose is an average of what the level of glucose has been over a period of about 5-8 hours (the time period from last urination)<ref>[http://www.noahcompendium.co.uk/Intervet_Schering-Plough/Caninsulin/-28708.html NOAH Compendium UK-Caninsulin Dosage & Administration]</ref>. |
− | Urine testing<ref>[http://www.dvmnewsmagazine.com/dvm/article/articleDetail.jsp?id=5336 DVMNews:Glucose Testing-Blood vs Urine Tests]</ref> also makes it more difficult to determine whether any [[hyperglycemia]] noted is the result of a [[Somogyi]] rebound pattern or a true need for an increase in insulin dosage. |
+ | Urine testing<ref>[http://www.dvmnewsmagazine.com/dvm/article/articleDetail.jsp?id=5336 DVMNews:Glucose Testing-Blood vs Urine Tests]</ref> also makes it more difficult to determine whether any [[hyperglycemia]] noted is the result of a [[Somogyi]] rebound pattern or a true need for an increase in insulin dosage. Urine only tests positive for glucose when the [[renal threshold]] has been exceeded for a length of time<ref>[http://web.archive.org/web/20061104180550/http://www.caninsulin.com/documents/061626.pdf Caninsulin-Monitoring-Page 5]</ref>. |
There also must be some degree of [[glycosuria]] (glucose in urine) present in order for a urine test to detect development of [[hypoglycemia]]<ref>[http://www.noahcompendium.co.uk/Intervet_UK_Ltd/Caninsulin/-28708.html NOAH Compendium UK-Caninsulin-Dosage & Administration]</ref>. |
There also must be some degree of [[glycosuria]] (glucose in urine) present in order for a urine test to detect development of [[hypoglycemia]]<ref>[http://www.noahcompendium.co.uk/Intervet_UK_Ltd/Caninsulin/-28708.html NOAH Compendium UK-Caninsulin-Dosage & Administration]</ref>. |
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==Reading Results== |
==Reading Results== |
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+ | |||
− | '''Evaluating the results.''' The stix bottle has instructions and color charts to show you how the color on the stix will change given the level of ketones/glucose in the urine over 15 (ketones) or 30 (glucose) seconds. Be sure to read the colors at those time intervals because the colors will continue to darken and a later reading will be an incorrect result. Timing with a clock or watch second hand instead of counting is said to be more accurate<ref>[http://www.uchsc.edu/misc/diabetes/ud05.pdf]</ref>. |
+ | '''Evaluating the results.''' The stix bottle has instructions and color charts to show you how the color on the stix will change given the level of ketones/glucose in the urine over 15 (ketones) or 30 (glucose) seconds. Be sure to read the colors at those time intervals because the colors will continue to darken and a later reading will be an incorrect result. Timing with a clock or watch second hand instead of counting is said to be more accurate<ref>[http://www.uchsc.edu/misc/diabetes/books/ud11/ud05.pdf Ketone Testing]</ref>. |
* If you see a "trace" or more of ketones, see [[ketones]]. |
* If you see a "trace" or more of ketones, see [[ketones]]. |
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+ | In a diabetic, '''any urinary ketones above trace, or any increase in urinary ketone level, or trace urinary ketones plus some of the symptoms above''', are cause to call an emergency vet immediately, at any hour of the day. |
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+ | |} |
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+ | When testing urine for ketones, the sample needs to be as fresh as possible. Ketones evaporate quickly, so there's a chance of getting a false negative test result if you're testing older urine<ref>[http://www.vet.uga.edu/VPP/clerk/Sine/index.php Urinalysis Dipstick Interpretations-University of Georgia-Ketones]</ref>. |
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+ | |||
+ | At low levels, ketones can be detected in the urine (ketonuria) before they are found in the blood (ketonemia/ketonaemia)<ref>[http://archive.student.bmj.com/issues/09/02/education/68.php BMJ Student Archive-Glycosuria and Ketonuria]</ref>. |
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+ | |||
+ | [[Image:Ketodiastix.jpg|left|thumb|250px|Ketodiastix--measures urine glucose and ketones.]] |
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+ | |||
* The glucose portion of the stix measures your pet's [[glycosuria]]--that is, the glucose that has collected in your pet's bladder since s/he last urinated. If you see any color change in the glucose portion of the stix, that means that your pet has exceeded its [[renal threshhold]] since it last urinated. The darker the color, the higher your pet's BG level has been since its last [[urination]]. Note that positive urinary glucose results are ''not'' indicative of your pet's [[blood glucose level]] at the time it urinated. No meaningful conversion between urine glucose and blood glucose readings is possible. |
* The glucose portion of the stix measures your pet's [[glycosuria]]--that is, the glucose that has collected in your pet's bladder since s/he last urinated. If you see any color change in the glucose portion of the stix, that means that your pet has exceeded its [[renal threshhold]] since it last urinated. The darker the color, the higher your pet's BG level has been since its last [[urination]]. Note that positive urinary glucose results are ''not'' indicative of your pet's [[blood glucose level]] at the time it urinated. No meaningful conversion between urine glucose and blood glucose readings is possible. |
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⚫ | * If you are testing urine for glucose, the time you test likely affects results in this way: mid-day urine glucose tests would reflect the [[nadir]] of glucose in the system--this also represents the [[peak]] of the insulin. Morning urine glucose tests are frequently high. Seeing negative urine glucose test, especially repeated negative ones, can mean the pet is approaching [[hypoglycemia]]<ref>[http://bettermedicine.intervetusa.com/june2006/managing_diabetes.html Better Medicine E-newsletter |
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+ | |||
− | ==Medications & Urine Test Results== |
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+ | [[Image:Ketostix.jpg|thumb|250px|Ketostix--measures urine ketones.]] |
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+ | |||
⚫ | * If you are testing urine for glucose, the time you test likely affects results in this way: mid-day urine glucose tests would reflect the [[nadir]] of glucose in the system--this also represents the [[peak]] of the insulin. Morning urine glucose tests are frequently high. Seeing negative urine glucose test, especially repeated negative ones, can mean the pet is approaching [[hypoglycemia]]<ref>[http://web.archive.org/web/20070208103248/http://bettermedicine.intervetusa.com/june2006/managing_diabetes.html Better Medicine E-newsletter June 2006]</ref>. |
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+ | |||
+ | ==False Testing Results-Urine Glucose== |
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+ | |||
+ | See [[Urine testing stix]], [http://petdiabetes.wikia.com/wiki/Urine_testing_stix#Reading_Results Reading Results] for examples of ketodiastix and ketostix color charts. |
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+ | |||
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+ | |- |
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+ | ! colspan=2 align="center" style="background:powderblue;"| |
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+ | ''' Possible False Urine Glucose Test Results'''<br>'''Antibiotics''' |
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! width="250" align="center" style="background:powderblue;" |Antibiotic<ref>[http://avmajournals.avma.org/doi/abs/10.2460/javma.2004.224.1455?prevSearch=allfield%3A%28diabetes%29 Cephalexin/Keflex, Enrofloxacin/Baytril & Inaccurate Urine Glucose Testing in Dogs]</ref>/Sulfa<ref>[http://www.petalk.com/drug-dosages.html#Sulfonamides PetTalk.com-Sulfonamides]</ref><ref>[http://www.petalk.com/drug-dosages.html#Trimethoprim PetTalk.com-Trimethoprim]</ref><ref>[http://www.petalk.com/drug-dosages.html#Ormetoprim PetTalk.com-Ormetoprim]</ref> drug name |
! width="250" align="center" style="background:powderblue;" |Antibiotic<ref>[http://avmajournals.avma.org/doi/abs/10.2460/javma.2004.224.1455?prevSearch=allfield%3A%28diabetes%29 Cephalexin/Keflex, Enrofloxacin/Baytril & Inaccurate Urine Glucose Testing in Dogs]</ref>/Sulfa<ref>[http://www.petalk.com/drug-dosages.html#Sulfonamides PetTalk.com-Sulfonamides]</ref><ref>[http://www.petalk.com/drug-dosages.html#Trimethoprim PetTalk.com-Trimethoprim]</ref><ref>[http://www.petalk.com/drug-dosages.html#Ormetoprim PetTalk.com-Ormetoprim]</ref> drug name |
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! bgcolor="ivory"|less than accurate<br>(false negatives & positives)<br> urine glucose test results<ref>[http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/191215.htm Merck Veterinary Manual-Cephalosporins and Cephamycins-Special Clinical Concerns]</ref> |
! bgcolor="ivory"|less than accurate<br>(false negatives & positives)<br> urine glucose test results<ref>[http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/191215.htm Merck Veterinary Manual-Cephalosporins and Cephamycins-Special Clinical Concerns]</ref> |
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− | ! width="200" style="background:ivory;"|Gantrisin, Septra<br>Bactrim, Albon<ref>[http://www.medi-vet.com/detail.aspx~ID~2156 Medi-Vet.com-Albon]</ref><br>Chanoprim (UK)<ref>[http://www.noahcompendium.co.uk/Chanelle_Animal_Health_Limited/Chanoprim_20/-35333.html NOAH Compendium-UK-Chanoprim]</ref><br>Duphatrim (UK)<ref>[http://www.noahcompendium.co.uk/Fort_Dodge_Animal_Health/Duphatrim_20_Tablets/-32592.html NOAH Compendium-UK-Duphatrim]</ref> <br>Tribrissen (UK)<ref>[http://www.noahcompendium.co.uk/ |
+ | ! width="200" style="background:ivory;"|Gantrisin, Septra<br>Bactrim, Albon<ref>[http://web.archive.org/web/20080105122617/http://www.medi-vet.com/detail.aspx~ID~2156 Medi-Vet.com-Albon]</ref><br>Chanoprim (UK)<ref>[http://www.noahcompendium.co.uk/Chanelle_Animal_Health_Limited/Chanoprim_20/-35333.html NOAH Compendium-UK-Chanoprim]</ref><br>Duphatrim (UK)<ref>[http://www.noahcompendium.co.uk/Fort_Dodge_Animal_Health/Duphatrim_20_Tablets/-32592.html NOAH Compendium-UK-Duphatrim]</ref> <br>Tribrissen (UK)<ref>[http://www.noahcompendium.co.uk/Intervet_Schering-Plough/Tribrissen_80_Tablets/-34781.html NOAH Compendium-UK-Tribrissen]</ref><br>Trinacol (UK)<ref>[http://www.noahcompendium.co.uk/Boehringer_Ingelheim_Limited/Trinacol_Injection_Solution_for_Injection/-26666.html NOAH Compendium-UK-Trinacol]</ref><br>more names at link<ref>[http://www.merckvetmanual.com/mvm/htm/bc/tphm40.htm Merck Veterinary Manual-Dose Rates of Sulfonamides]</ref> |
− | ! bgcolor="ivory" |can alter urine glucose<br> test results<ref>[http:// |
+ | ! bgcolor="ivory" |can alter urine glucose<br> test results<ref>[http://www.wellness.com/reference/conditions/hypoglycemia/ Sulfa Drugs by Brand Name & Hypoglycemia]</ref><ref>[http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/191247.htm Merck Veterinary Manual-Sulfonamides and Sulfonamide Combinations-Special Clinical Concerns]</ref> |
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! width="200" style="background:ivory;"|Chloramphenichol<ref>[http://www.petalk.com/drug-dosages.html#Chloramphenicol PetTalk.com-Chloramphenichol]</ref><br>Chloromycetin<ref>[http://www.healthtouch.com/diabetesplace/ask-interactions.asp?cid=HTFEAT&cname=Healthtouch Chloramphenichol/Chloromycetin & Blood Glucose]</ref> |
! width="200" style="background:ivory;"|Chloramphenichol<ref>[http://www.petalk.com/drug-dosages.html#Chloramphenicol PetTalk.com-Chloramphenichol]</ref><br>Chloromycetin<ref>[http://www.healthtouch.com/diabetesplace/ask-interactions.asp?cid=HTFEAT&cname=Healthtouch Chloramphenichol/Chloromycetin & Blood Glucose]</ref> |
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! bgcolor="ivory" |can produce false<br> urine glucose test results<ref>[http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/191262.htm Merck Veterinary Manual-Chloramphenicol and Congeners-Special Clinical Concerns]</ref>. |
! bgcolor="ivory" |can produce false<br> urine glucose test results<ref>[http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/191262.htm Merck Veterinary Manual-Chloramphenicol and Congeners-Special Clinical Concerns]</ref>. |
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− | ! width="200" style="background:ivory;"|Tetracycline<ref>[http://www.petalk.com/drug-dosages.html#Tetracycline PetTalk.com-Tetracycline]</ref><br>Helidac,Sumycin<ref>[http://www.nlm.nih.gov/medlineplus/druginfo/ |
+ | ! width="200" style="background:ivory;"|Tetracycline<ref>[http://www.petalk.com/drug-dosages.html#Tetracycline PetTalk.com-Tetracycline]</ref><br>Helidac,Sumycin<ref>[http://www.nlm.nih.gov/medlineplus/druginfo/meds/a682098.html Tetracycline Medications & False Urine Test Results]</ref><br>Doxycycline<ref>[http://www.petalk.com/drug-dosages.html#Doxycycline PetTalk.com-Doxycycline]</ref><br>Doryx, Doxy 100<br>Monodox, Vibramycin<br>Vibra-Tabs, Ronaxan (UK) <ref>[http://www.noahcompendium.co.uk/Merial_Animal_Health_Ltd/Ronaxan/-31744.html NOAH Compendium-UK-Ronaxan]</ref><br>'''Doxyseptin''' (UK)<ref>[http://www.noahcompendium.co.uk/V_AOk-toquinol_UK_Ltd/Doxyseptin_300/-31879.html NOAH Compendium-UK-Doxyseptin]</ref> |
− | ! bgcolor="ivory" |false urine glucose test results<ref>[http://www.nlm.nih.gov/medlineplus/druginfo/ |
+ | ! bgcolor="ivory" |false urine glucose test results<ref>[http://www.nlm.nih.gov/medlineplus/druginfo/meds/a682063.html Doxycycline Medications & False Urine Test Results]</ref> |
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! width="200" style="background:ivory;"|Penicillin and its derivatives<br>ampicillin<br> carbenicillin<br>ticarcillin<br>penicillin G<br>other names at links<ref>[http://www.merckvetmanual.com/mvm/htm/bc/tphm29.htm Merck Veterinary Manual-Dose Rate of Penicillins-More Generic & Brand Names of Penicillin Family Drugs]</ref><ref>[http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202446.html US National Institutes of Health-Medline-Penicillins]</ref> |
! width="200" style="background:ivory;"|Penicillin and its derivatives<br>ampicillin<br> carbenicillin<br>ticarcillin<br>penicillin G<br>other names at links<ref>[http://www.merckvetmanual.com/mvm/htm/bc/tphm29.htm Merck Veterinary Manual-Dose Rate of Penicillins-More Generic & Brand Names of Penicillin Family Drugs]</ref><ref>[http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202446.html US National Institutes of Health-Medline-Penicillins]</ref> |
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! bgcolor="ivory" |can produce false positive<br> urine glucose test results<ref>[http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/191208.htm Merck Veterinary Manual-Penicillins-Special Clinical Concerns]</ref>. |
! bgcolor="ivory" |can produce false positive<br> urine glucose test results<ref>[http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/191208.htm Merck Veterinary Manual-Penicillins-Special Clinical Concerns]</ref>. |
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− | ''' Possible False Urine |
+ | ''' Possible False Urine Glucose Test Results'''<br>'''Other Drugs''' |
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− | ! width="250"align="center" style="background:ivory;"|''' |
+ | ! width="250"align="center" style="background:ivory;"|'''Acetaminophen'''<ref>[http://www.health.com/health/library/mdp/0,,d03324a1,00.html Health.com-Acetaminophen],</ref> (brand names)<br>'''Tylenol''' |
− | !style="background:ivory;"|Common use:<br> |
+ | !style="background:ivory;"|Common use:<br>Pain reliever. |
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− | !style="background:ivory;"| |
+ | !style="background:ivory;"|'''Aspirin'''<ref>[http://www.elephantcare.org/Drugs/aspirin.htm Aspirin-elephantcare.org]</ref> |
− | !style="background:ivory;"|Common use:<br> |
+ | !style="background:ivory;"|Common use:<br>Pain reliever.<br>False positives possible (With urine test brand name Clinitest.)<br>False negatives possible (With urine test brand names Clinistix or TesTape.) |
+ | |- |
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+ | !style="background:ivory;"|'''Salicylates'''<br>Pepto-Bismol, etc.<ref>[http://www.elephantcare.org/Drugs/bismuths.htm Bismuth subsalicylate-elephantcare.org]</ref> |
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+ | !style="background:ivory;"|Common use:<br>Diarrhea.<br>False positives possible (With urine test brand name Clinitest.)<br>False negatives possible (With urine test brand names Clinistix or TesTape.) |
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+ | |- |
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+ | !style="background:ivory;"|'''Phenazopyridine'''<br>Pyridium, Geridium, Pyridiate, or Urogesic |
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+ | !style="background:ivory;"|Common use:<br>Urinary tract infections.<br>False positives possible (With urine test brand name TesTape.)<br>Delayed reactions possible (With urine test brand names Clinistix or TesTape.)<ref>[http://www.merck.com/mmpe/print/lexicomp/phenazopyridine.html Merck Manuals Online-Phenazopyridine]</ref> |
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+ | |- |
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+ | ! width="250"align="center" style="background:ivory;"|'''Diazepam'''<ref>[http://www.elephantcare.org/Drugs/diazepam.htm Diazepam/Valium Elephantcare.org],</ref> (brand names)<br>'''Valium''' |
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+ | !style="background:ivory;"|Negative.<br>Common uses:<br>Seizures, anxiety, muscle relaxant, [[Inappetance|appetite stimulant]].<br>(With urine tests brand names Diastix and Clinistix.) |
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!style="background:ivory;"|'''False negative urine glucose''' test results<br> |
!style="background:ivory;"|'''False negative urine glucose''' test results<br> |
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− | (With urine test brand name '''Clinistix''')<ref>[http://www.provet.co.uk/health/diagnostics/pilivitc.htm Vitamin C & False Test Results in Pets-Provet-UK]</ref>. |
+ | (With urine test brand name '''Clinistix''')<ref>[http://www.provet.co.uk/health/diagnostics/pilivitc.htm Vitamin C & False Test Results in Pets-Provet-UK]</ref>. |
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! width="250"align="center" style="background:ivory;"|'''Urine Testing''' |
! width="250"align="center" style="background:ivory;"|'''Urine Testing''' |
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− | !style="background:ivory;"|'''False negative urine |
+ | !style="background:ivory;"|'''False negative urine glucose''' test results<br> |
+ | With other urine test brand name strips<ref>[http://www.vet.uga.edu/VPP/clerk/Sine/index.php Urinalysis Dipstick Interpretations-Glucose-University of Georgia]</ref>. |
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+ | {| align=center width="500" border="1" style="background:powderblue;" | |
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+ | |- |
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+ | ! colspan=2 align="center" style="background:powderblue;"| |
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+ | ''' Possible False Urine Glucose Test Results-Other Reasons''' |
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+ | |- |
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+ | ! width="250"align="center" style="background:ivory;"|'''Moderate Ketones'''<ref>[http://www.vet.uga.edu/VPP/clerk/Sine/index.php Urinalysis Dipstick Interpretations-Glucose-University of Georgia]</ref> |
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+ | !style="background:ivory;"|Negative if glucose is only slightly elevated. |
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+ | |- |
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+ | ! width="250"align="center" style="background:ivory;"|'''Increased Urine Specific Gravity'''<ref>[http://www.vet.uga.edu/VPP/clerk/Sine/index.php Urinalysis Dipstick Interpretations-Glucose-University of Georgia]</ref> |
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+ | !style="background:ivory;"|Negative. |
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+ | |- |
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+ | ! width="250"align="center" style="background:ivory;"|'''Decreased Temperature'''<ref>[http://www.vet.uga.edu/VPP/clerk/Sine/index.php Urinalysis Dipstick Interpretations-Glucose-University of Georgia]</ref> |
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+ | !style="background:ivory;"|Negative-refrigerated samples. |
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+ | |- |
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+ | ! width="250"align="center" style="background:ivory;"|'''Very Concentrated Urine''' |
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+ | !style="background:ivory;"|Negative<ref>[http://www.dcavm.org/06technov.html District of Columbia Academy-Veterinary Medicine Nov 2006-Urinalysis: Glucose]</ref>. |
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+ | |- |
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+ | ! width="250"align="center" style="background:ivory;"|'''Expired Test Strips'''<ref>[http://www.vet.uga.edu/VPP/clerk/Sine/index.php Urinalysis Dipstick Interpretations-Glucose-University of Georgia]</ref> |
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+ | !style="background:ivory;"|Negative. |
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+ | |- |
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+ | ! width="250"align="center" style="background:ivory;"|'''Old Urine Sample'''<ref>[http://www.entrepreneur.com/tradejournals/article/16085378_2.html Optimizing Results with Urinalysis Dipsticks]</ref> |
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+ | !style="background:ivory;"|Negative.<br>Bacterial metabolism of urine at room temperatures for extended periods. |
||
+ | |- |
||
+ | ! width="250"align="center" style="background:ivory;"|'''Contaminated Sample'''<ref>[http://www.vet.uga.edu/VPP/clerk/Sine/index.php Urinalysis Dipstick Interpretations-Glucose-University of Georgia]</ref> |
||
+ | !style="background:ivory;"|Positive with oxidant contamination such as bleach or hydrogen peroxide. |
||
+ | |- |
||
+ | ! width="250"align="center" style="background:ivory;"|'''Feline Urinary Obstruction'''<ref>[http://www.vet.uga.edu/VPP/clerk/Sine/index.php Urinalysis Dipstick Interpretations-Glucose-University of Georgia]</ref> |
||
+ | !style="background:ivory;"|Positive-pseudoglucose<ref>[http://www.dcavm.org/06technov.html District of Columbia Academy-Veterinary Medicine Nov 2006-Urinalysis: Glucose]</ref>. |
||
+ | |} |
||
If your pet is taking any type of vitamin supplements, it should be noted on his or her medical records. Knowing that he/she is using them means being able to factor them into interpretations of test results. |
If your pet is taking any type of vitamin supplements, it should be noted on his or her medical records. Knowing that he/she is using them means being able to factor them into interpretations of test results. |
||
+ | |||
+ | ==False Testing Results-Urine Ketones== |
||
+ | |||
+ | {| align=center width="500" border="1" style="background:powderblue;" | |
||
+ | |- |
||
+ | ! colspan=2 align="center" style="background:powderblue;"| |
||
+ | ''' Possible False Urine Ketone Test Results'''<br>'''Drugs and Supplements''' |
||
+ | |- |
||
+ | ! width="250"align="center" style="background:ivory;"|'''Valproic Acid''' (brand names)<br>'''Depakene''', '''Depakote''', '''Divalproex Sodium'''<ref>[http://www.netdoctor.co.uk/medicines/100000597.html NetDoctor UK-Valproic Acid]</ref> |
||
+ | !style="background:ivory;"|Positive.<br>Common use:<br> Treatment of epilepsy. |
||
+ | |- |
||
+ | !style="background:ivory;"|Cefixime/Suprax<ref>[http://www.rxlist.com/cgi/generic/cefixime_ad.htm RXList.com-Suprax/Cefixime]</ref> |
||
+ | !style="background:ivory;"|Positive with nitroprusside-based urine testing.<br>Common use:<br>Antibiotic. |
||
+ | |- |
||
+ | !style="background:ivory;"|Levadopa Metabolites<ref>[http://www.drugs.com/mtm/levodopa.html Drugs.com-Levadopa]</ref> |
||
+ | !style="background:ivory;"|Positive with high concentrations<ref>[http://www.vet.uga.edu/VPP/clerk/Sine/index.php Urinalysis Dipstick Interpretations-Ketones-University of Georgia]</ref>. |
||
+ | |- |
||
+ | !style="background:ivory;"|Tricyclic Ring Compounds<ref>[http://www.dcavm.org/06technov.html District of Columbia Academy of Veterinary Medicine November 2006 Clinical Lab Medicine Harvesting The Gold: Interpretation and Techniques of Urinalysis]</ref><ref>[http://en.wikipedia.org/wiki/Tricyclic_antidepressant Wikipedia-Tricyclic Antidepressant]</ref> |
||
+ | !style="background:ivory;"|Positive. <br>Common use:<br>Treatment of depression. |
||
+ | |- |
||
+ | !style="background:ivory;"|Captopril<br>other drugs with<br>free sulfhydryl groups<ref>[http://www.dcavm.org/06technov.html District of Columbia Academy of Veterinary Medicine November 2006 Clinical Lab Medicine Harvesting The Gold: Interpretation and Techniques of Urinalysis]</ref> |
||
+ | !style="background:ivory;"|Positive. <br> Captopril Common use:<br>Hypertension<br>(high blood pressure),<br>various heart conditions, <br>preserving kidney function<br>in diabetic nephropathy<ref>[http://en.wikipedia.org/wiki/Captopril Wikipedia-Captopril]</ref>. |
||
+ | |- |
||
+ | !style="background:ivory;"|Phenazopyridine<br>Pyridium, Geridium, Pyridiate, or Urogesic<ref>[http://www.diabetesexplained.com/ketone-test.html Diabetes Explained-Ketone Test Explained]</ref><ref>[http://www.merck.com/mmpe/print/lexicomp/phenazopyridine.html Merck Manuals Online-Phenazopyridine]</ref>. |
||
+ | !style="background:ivory;"|Positive. <br> Common use:<br>Urinary tract infections. |
||
+ | |- |
||
+ | !style="background:ivory;"|Glucocorticoids/[[Steroids]]<ref>[http://www.nlm.nih.gov/MEDLINEPLUS/ency/article/003585.htm Medline Plus-National Institutes of Health-Ketones]</ref> |
||
+ | !style="background:ivory;"|Positive. <br> Common use:<br>Allergies, replacement therapy, others. |
||
+ | |- |
||
+ | !style="background:ivory;"|Vitamin C Supplements<ref>[http://www.abbottdiabetescare.com/adc_dotcom/url/content/en_US/20.10.30:30/general_content/General_Content_0000068.htm Precision Xtra Blood Ketone Test Strips]</ref> |
||
+ | !style="background:ivory;"|Negative. |
||
+ | |} |
||
+ | {| align=center width="500" border="1" style="background:powderblue;" | |
||
+ | |- |
||
+ | ! colspan=2 align="center" style="background:powderblue;"| |
||
+ | ''' Possible False Urine Ketone Test Results-Other Reasons''' |
||
+ | |- |
||
+ | ! width="250"align="center" style="background:ivory;"|'''Pigmented Urine'''<ref>[http://www.vet.uga.edu/VPP/clerk/Sine/index.php Urinalysis Dipstick Interpretations-Glucose-University of Georgia]</ref> |
||
+ | !style="background:ivory;"|Positive-Any other color except yellow or clear<ref>[http://www.dcavm.org/06technov.html District of Columbia Academy-Veterinary Medicine Nov 2006-Urinalysis: What Is Abnormal?]</ref>.<br> May be the result of other disease processes. |
||
+ | |- |
||
+ | ! width="250"align="center" style="background:ivory;"|'''Dehydration'''<ref>[http://www.diabetesexplained.com/ketone-test.html Diabetes Explained-Ketone Test Explained]</ref> |
||
+ | !style="background:ivory;"|Positive-<br>lack of fluids can concentrate ketones |
||
+ | |- |
||
+ | ! width="250"align="center" style="background:ivory;"|'''Old Urine Sample'''<ref>[http://www.vet.uga.edu/VPP/clerk/Sine/index.php Urinalysis Dipstick Interpretations-Glucose-University of Georgia]</ref> |
||
+ | !style="background:ivory;"|Negative-ketones can evaporate rapidly. |
||
+ | |} |
||
==Getting samples== |
==Getting samples== |
||
Line 95: | Line 203: | ||
==Further Reading== |
==Further Reading== |
||
[[Image:Wikicat3.jpg|100px]] |
[[Image:Wikicat3.jpg|100px]] |
||
− | *[http://www.uq.edu.au/vetschool/centrecah/index.html?page=43391&pid=0 Understanding Feline Diabetes Mellitus: Pathogenesis and Management-U Queensland 2005-Rand/Marshall]<br>Section with information on how to monitor urine for cats using Lantus (glargine) who won't allow regular blood glucose testing. |
+ | *[http://www.uq.edu.au/vetschool/centrecah/index.html?page=43391&pid=0 Understanding Feline Diabetes Mellitus: Pathogenesis and Management-U Queensland 2005-Rand/Marshall]<br />Section with information on how to monitor urine for cats using Lantus (glargine) who won't allow regular blood glucose testing. |
Line 103: | Line 211: | ||
*[http://www.peteducation.com/article.cfm?cls=0&cat=1474&articleid=3136 Urinanalysis: Obtaining a Urine Sample Drs. Foster & Smith Pet Education Library] |
*[http://www.peteducation.com/article.cfm?cls=0&cat=1474&articleid=3136 Urinanalysis: Obtaining a Urine Sample Drs. Foster & Smith Pet Education Library] |
||
− | *[http://www.felinevideos.vet.cornell.edu/diabetes/5.htm Cornell University-Feline Health Center-Urine Monitoring Flash Movie]<br>Ways to Collect Test Urine and How to Read Ketone Test Strips. |
+ | *[http://www.felinevideos.vet.cornell.edu/diabetes/5.htm Cornell University-Feline Health Center-Urine Monitoring Flash Movie]<br />Ways to Collect Test Urine and How to Read Ketone Test Strips. |
+ | |||
+ | *[http://www.vet.uga.edu/VPP/clerk/Sine/index.php Urinalysis Dipstick Interpretation-University of Georgia]<br />How to read multi-screen urine testing strips. |
||
+ | |||
+ | *[http://ivermectinfordogs.org/dog-ear-infection Dog ear infection] |
||
+ | *[http://ivermectinfordogs.org/pancreatitis-in-dogs Pancreatitis in dogs] |
||
+ | *[http://ivermectinfordogs.org Ivermectin for dogs] |
||
+ | *[http://ivermectinfordogs.org/how-long-are-dogs-pregnant-before-they-giving-birth How long are dogs pregnant ] |
||
+ | *[http://ivermectinfordogs.org/why-do-dogs-eat-grass Why do dogs eat grass ] |
||
+ | *[http://ivermectinfordogs.org/save-5-off-with-purina-dog-chow-coupons Purina dog chow coupons ] |
||
+ | [[Category:Supplies]] |
||
+ | [[Category:Tips]] |
||
+ | [[Category:Terms]] |
||
+ | [[Category:Introduction]] |
||
==References== |
==References== |
Latest revision as of 10:16, 11 February 2013
Human and animal diabetics both use ketostix or ketodiastix. These are reagent indicator strips that test urine for only ketone (ketostix) or for both ketones and glucose (ketodiastix). These links show examples of Ketostix[1] and Ketodiastix[2].
These stix are available at any brick-and-mortar or Internet pharmacy that sells human diabetic supplies. Stix do expire, so check the unopened expiration date when you buy them and record the date you open them. Keep the bottle tightly closed when not in use; prolonged exposure to air can produce false negative urine ketone test results[3].
If the foil-wrapped Ketostix, rather than the ones in vials are purchased, you may find it less wasteful. After the bottle is opened, the remaining unused strips have only a 6 months' life. By using the foil-wrapped ones, you can extend the "life" of your purchase. The singly-wrapped ones can have a unopened expiration date of up to two years. You are then only using what you need when you need it, having the rest still sealed and potent until the indicated expiration date[4].
Testing reasons
You should test your pet's urine for ketones for the reasons discussed at ketones. You may test your pet's urine for glucose because (1) you've been instructed to do so by the vet as a method of gauging regulation, (2) your pet is undiagnosed and you want to determine whether there is hyperglycemia, or (3) your cat is in remission and you want to determine whether there is hyperglycemia.
Urine Glucose Testing
Some reasons for preferring testing glucose levels by using blood over urine testing is that the urine used in testing may have been in the bladder for hours. Because of this, it may not be a reliable indicator of what systemic glucose levels are at the time of testing[5]. What's seen when testing urine for glucose is an average of what the level of glucose has been over a period of about 5-8 hours (the time period from last urination)[6].
Urine testing[7] also makes it more difficult to determine whether any hyperglycemia noted is the result of a Somogyi rebound pattern or a true need for an increase in insulin dosage. Urine only tests positive for glucose when the renal threshold has been exceeded for a length of time[8].
There also must be some degree of glycosuria (glucose in urine) present in order for a urine test to detect development of hypoglycemia[9].
Reading Results
Evaluating the results. The stix bottle has instructions and color charts to show you how the color on the stix will change given the level of ketones/glucose in the urine over 15 (ketones) or 30 (glucose) seconds. Be sure to read the colors at those time intervals because the colors will continue to darken and a later reading will be an incorrect result. Timing with a clock or watch second hand instead of counting is said to be more accurate[10].
- If you see a "trace" or more of ketones, see ketones.
In a diabetic, any urinary ketones above trace, or any increase in urinary ketone level, or trace urinary ketones plus some of the symptoms above, are cause to call an emergency vet immediately, at any hour of the day. |
When testing urine for ketones, the sample needs to be as fresh as possible. Ketones evaporate quickly, so there's a chance of getting a false negative test result if you're testing older urine[11].
At low levels, ketones can be detected in the urine (ketonuria) before they are found in the blood (ketonemia/ketonaemia)[12].
- The glucose portion of the stix measures your pet's glycosuria--that is, the glucose that has collected in your pet's bladder since s/he last urinated. If you see any color change in the glucose portion of the stix, that means that your pet has exceeded its renal threshhold since it last urinated. The darker the color, the higher your pet's BG level has been since its last urination. Note that positive urinary glucose results are not indicative of your pet's blood glucose level at the time it urinated. No meaningful conversion between urine glucose and blood glucose readings is possible.
- If you are testing urine for glucose, the time you test likely affects results in this way: mid-day urine glucose tests would reflect the nadir of glucose in the system--this also represents the peak of the insulin. Morning urine glucose tests are frequently high. Seeing negative urine glucose test, especially repeated negative ones, can mean the pet is approaching hypoglycemia[13].
False Testing Results-Urine Glucose
See Urine testing stix, Reading Results for examples of ketodiastix and ketostix color charts.
Possible False Urine Glucose Test Results | |
---|---|
Antibiotic[14]/Sulfa[15][16][17] drug name | Effects |
cephalexin, Keflex[18] Cephorum (UK),[19]Rilexine[20] Cefixime/Suprax[21] Cefotixin/Mefoxin[22] Cefpodoxime Proxetil/Simplicef[23]Cefotaxime/Claforan[24] other cephalosporin antibiotics[25] enrofloxacin[26] Baytril[27] |
less than accurate (false negatives & positives) urine glucose test results[28] |
Gantrisin, Septra Bactrim, Albon[29] Chanoprim (UK)[30] Duphatrim (UK)[31] Tribrissen (UK)[32] Trinacol (UK)[33] more names at link[34] |
can alter urine glucose test results[35][36] |
Chloramphenichol[37] Chloromycetin[38] |
can produce false urine glucose test results[39]. |
Tetracycline[40] Helidac,Sumycin[41] Doxycycline[42] Doryx, Doxy 100 Monodox, Vibramycin Vibra-Tabs, Ronaxan (UK) [43] Doxyseptin (UK)[44] |
false urine glucose test results[45] |
Penicillin and its derivatives ampicillin carbenicillin ticarcillin penicillin G other names at links[46][47] |
can produce false positive urine glucose test results[48]. |
Possible False Urine Glucose Test Results | |
---|---|
Acetaminophen[49] (brand names) Tylenol |
Common use: Pain reliever. |
Aspirin[50] | Common use: Pain reliever. False positives possible (With urine test brand name Clinitest.) False negatives possible (With urine test brand names Clinistix or TesTape.) |
Salicylates Pepto-Bismol, etc.[51] |
Common use: Diarrhea. False positives possible (With urine test brand name Clinitest.) False negatives possible (With urine test brand names Clinistix or TesTape.) |
Phenazopyridine Pyridium, Geridium, Pyridiate, or Urogesic |
Common use: Urinary tract infections. False positives possible (With urine test brand name TesTape.) Delayed reactions possible (With urine test brand names Clinistix or TesTape.)[52] |
Diazepam[53] (brand names) Valium |
Negative. Common uses: Seizures, anxiety, muscle relaxant, appetite stimulant. (With urine tests brand names Diastix and Clinistix.) |
Possible False Test Results | |
---|---|
Blood Chemistry | Decreased blood glucose and cholesterol test levels. |
Urine Testing | False high urine glucose test results (With urine test brand name Clinitest)[56]. |
Urine Testing | False negative urine glucose test results (With urine test brand name Clinistix)[57]. |
Urine Testing | False negative urine glucose test results With other urine test brand name strips[58]. |
Possible False Urine Glucose Test Results-Other Reasons | |
---|---|
Moderate Ketones[59] | Negative if glucose is only slightly elevated. |
Increased Urine Specific Gravity[60] | Negative. |
Decreased Temperature[61] | Negative-refrigerated samples. |
Very Concentrated Urine | Negative[62]. |
Expired Test Strips[63] | Negative. |
Old Urine Sample[64] | Negative. Bacterial metabolism of urine at room temperatures for extended periods. |
Contaminated Sample[65] | Positive with oxidant contamination such as bleach or hydrogen peroxide. |
Feline Urinary Obstruction[66] | Positive-pseudoglucose[67]. |
If your pet is taking any type of vitamin supplements, it should be noted on his or her medical records. Knowing that he/she is using them means being able to factor them into interpretations of test results.
False Testing Results-Urine Ketones
Possible False Urine Ketone Test Results | |
---|---|
Valproic Acid (brand names) Depakene, Depakote, Divalproex Sodium[68] |
Positive. Common use: Treatment of epilepsy. |
Cefixime/Suprax[69] | Positive with nitroprusside-based urine testing. Common use: Antibiotic. |
Levadopa Metabolites[70] | Positive with high concentrations[71]. |
Tricyclic Ring Compounds[72][73] | Positive. Common use: Treatment of depression. |
Captopril other drugs with free sulfhydryl groups[74] |
Positive. Captopril Common use: Hypertension (high blood pressure), various heart conditions, preserving kidney function in diabetic nephropathy[75]. |
Phenazopyridine Pyridium, Geridium, Pyridiate, or Urogesic[76][77]. |
Positive. Common use: Urinary tract infections. |
Glucocorticoids/Steroids[78] | Positive. Common use: Allergies, replacement therapy, others. |
Vitamin C Supplements[79] | Negative. |
Possible False Urine Ketone Test Results-Other Reasons | |
---|---|
Pigmented Urine[80] | Positive-Any other color except yellow or clear[81]. May be the result of other disease processes. |
Dehydration[82] | Positive- lack of fluids can concentrate ketones |
Old Urine Sample[83] | Negative-ketones can evaporate rapidly. |
Getting samples
How to catch urine. Some people place the stix under their pet's stream when s/he is urinating. Others catch urine in a dedicated spoon, ladle, or other collection device and dip the stix into the urine. Sometimes, catching urine from a cat requires stalking it. This can be a challenge in the UK where many cats are allowed outdoors to relieve themselves. Still others confine the cat to a small space (a bathroom) with an empty or almost empty litter box covered with plastic wrap that will catch the urine. Intervet has Internet pages with some ideas for performing urine tests on cats[84] and dogs[85]. More tips[86] on collecting uring samples for dogs.
Further Reading
- Understanding Feline Diabetes Mellitus: Pathogenesis and Management-U Queensland 2005-Rand/Marshall
Section with information on how to monitor urine for cats using Lantus (glargine) who won't allow regular blood glucose testing.
- Cornell University-Feline Health Center-Urine Monitoring Flash Movie
Ways to Collect Test Urine and How to Read Ketone Test Strips.
- Urinalysis Dipstick Interpretation-University of Georgia
How to read multi-screen urine testing strips.
- Dog ear infection
- Pancreatitis in dogs
- Ivermectin for dogs
- How long are dogs pregnant
- Why do dogs eat grass
- Purina dog chow coupons
References
- ↑ Hocks.com Website: Ketostix
- ↑ Hocks.com Website: Ketodiastix
- ↑ Precision Xtra-Blood Ketone Test Strips
- ↑ Understanding Diabetes-Ketone Testing
- ↑ Pet Education.com-Drs. Foster & Smith-Blood Glucose Curves
- ↑ NOAH Compendium UK-Caninsulin Dosage & Administration
- ↑ DVMNews:Glucose Testing-Blood vs Urine Tests
- ↑ Caninsulin-Monitoring-Page 5
- ↑ NOAH Compendium UK-Caninsulin-Dosage & Administration
- ↑ Ketone Testing
- ↑ Urinalysis Dipstick Interpretations-University of Georgia-Ketones
- ↑ BMJ Student Archive-Glycosuria and Ketonuria
- ↑ Better Medicine E-newsletter June 2006
- ↑ Cephalexin/Keflex, Enrofloxacin/Baytril & Inaccurate Urine Glucose Testing in Dogs
- ↑ PetTalk.com-Sulfonamides
- ↑ PetTalk.com-Trimethoprim
- ↑ PetTalk.com-Ormetoprim
- ↑ Cephalexin/Keflex Information
- ↑ NOAH Compendium-UK-Cephorum
- ↑ NOAH Compendium-UK-Rilexine
- ↑ RXList.com-Suprax/Cefixime
- ↑ Cefotixin/Mefoxin=Petplace.com
- ↑ Cefpodoxime Proxetil/Simplicef-Petplace.com
- ↑ Cefotaxime/Claforan Petplace.com
- ↑ Merck Veterinary Manual-Dose Rates of Cephalosporins
- ↑ PetTalk.com-Enrofloxacin
- ↑ Enrofloxacin/Baytril Information
- ↑ Merck Veterinary Manual-Cephalosporins and Cephamycins-Special Clinical Concerns
- ↑ Medi-Vet.com-Albon
- ↑ NOAH Compendium-UK-Chanoprim
- ↑ NOAH Compendium-UK-Duphatrim
- ↑ NOAH Compendium-UK-Tribrissen
- ↑ NOAH Compendium-UK-Trinacol
- ↑ Merck Veterinary Manual-Dose Rates of Sulfonamides
- ↑ Sulfa Drugs by Brand Name & Hypoglycemia
- ↑ Merck Veterinary Manual-Sulfonamides and Sulfonamide Combinations-Special Clinical Concerns
- ↑ PetTalk.com-Chloramphenichol
- ↑ Chloramphenichol/Chloromycetin & Blood Glucose
- ↑ Merck Veterinary Manual-Chloramphenicol and Congeners-Special Clinical Concerns
- ↑ PetTalk.com-Tetracycline
- ↑ Tetracycline Medications & False Urine Test Results
- ↑ PetTalk.com-Doxycycline
- ↑ NOAH Compendium-UK-Ronaxan
- ↑ NOAH Compendium-UK-Doxyseptin
- ↑ Doxycycline Medications & False Urine Test Results
- ↑ Merck Veterinary Manual-Dose Rate of Penicillins-More Generic & Brand Names of Penicillin Family Drugs
- ↑ US National Institutes of Health-Medline-Penicillins
- ↑ Merck Veterinary Manual-Penicillins-Special Clinical Concerns
- ↑ Health.com-Acetaminophen,
- ↑ Aspirin-elephantcare.org
- ↑ Bismuth subsalicylate-elephantcare.org
- ↑ Merck Manuals Online-Phenazopyridine
- ↑ Diazepam/Valium Elephantcare.org,
- ↑ PetTalk.com-Vitamin C
- ↑ Vitamin C & False Test Results in Pets
- ↑ Vitamin C & False Test Results in Pets-Provet-UK
- ↑ Vitamin C & False Test Results in Pets-Provet-UK
- ↑ Urinalysis Dipstick Interpretations-Glucose-University of Georgia
- ↑ Urinalysis Dipstick Interpretations-Glucose-University of Georgia
- ↑ Urinalysis Dipstick Interpretations-Glucose-University of Georgia
- ↑ Urinalysis Dipstick Interpretations-Glucose-University of Georgia
- ↑ District of Columbia Academy-Veterinary Medicine Nov 2006-Urinalysis: Glucose
- ↑ Urinalysis Dipstick Interpretations-Glucose-University of Georgia
- ↑ Optimizing Results with Urinalysis Dipsticks
- ↑ Urinalysis Dipstick Interpretations-Glucose-University of Georgia
- ↑ Urinalysis Dipstick Interpretations-Glucose-University of Georgia
- ↑ District of Columbia Academy-Veterinary Medicine Nov 2006-Urinalysis: Glucose
- ↑ NetDoctor UK-Valproic Acid
- ↑ RXList.com-Suprax/Cefixime
- ↑ Drugs.com-Levadopa
- ↑ Urinalysis Dipstick Interpretations-Ketones-University of Georgia
- ↑ District of Columbia Academy of Veterinary Medicine November 2006 Clinical Lab Medicine Harvesting The Gold: Interpretation and Techniques of Urinalysis
- ↑ Wikipedia-Tricyclic Antidepressant
- ↑ District of Columbia Academy of Veterinary Medicine November 2006 Clinical Lab Medicine Harvesting The Gold: Interpretation and Techniques of Urinalysis
- ↑ Wikipedia-Captopril
- ↑ Diabetes Explained-Ketone Test Explained
- ↑ Merck Manuals Online-Phenazopyridine
- ↑ Medline Plus-National Institutes of Health-Ketones
- ↑ Precision Xtra Blood Ketone Test Strips
- ↑ Urinalysis Dipstick Interpretations-Glucose-University of Georgia
- ↑ District of Columbia Academy-Veterinary Medicine Nov 2006-Urinalysis: What Is Abnormal?
- ↑ Diabetes Explained-Ketone Test Explained
- ↑ Urinalysis Dipstick Interpretations-Glucose-University of Georgia
- ↑ Intervet-Urine Test Hints for Cats
- ↑ Intervet-Urine Test Hints for Dogs
- ↑ Healthypet.com Collecting Urine Samples