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Urine Transparency

Freshly voided urine is clear and transparent. Cloudy urine may be caused by crystals, deposits, white cells, red cells, epithelial cells or fat globules. Further evaluation with centrifugation, microscopic examination, heating or with ether generally determines the cause of the turbidity.

Substances that cause cloudiness but that are not considered unhealthy include mucus, sperm and prostatic fluid, cells from the skin, normal urine crystals, and contaminants such as body lotions and powders.


Causes of Turbid Urine

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Amorphous PhosphatesA normal constituent in alkaline or neutral urine
They dissolve upon addition of a dilute acid (e.g. acetic acid).
Amorphous UratesA normal constituent in acid urine
They often appear as yellow crystals
May be pink crystals ("brick dust") as a result of increased uroerythrin.
They dissolve upon warming to 40°C.
BacteriaOften seen as seen as a uniform cloud
They cannot be removed by ordinary filtration or centrifugation
Confirmed on microscopic examination
Blood (red blood cells)Usually associated with a reddish-brown, smoky appearance to the urine
Confirmed on microscopic examination or chemical tests for haemoglobin
Pus (white cells)May resemble amorphous phosphates to the naked eye
Microscopic examination confirms leucocytes.
Mucus and Epithelial CellsAppear as a faint cloud (nubecula) of mucus, leucocytes and epithelial cells upon cooling and standing
The nubecula of normal urine is probably due to nucleoprotein (phosphoprotein) and not a mucin or mucoid (glycoprotein)
Nebecula usually settles to the bottom, but in urine of high specific gravity may float near the middle.
Colloidal ParticlesCannot be cleared from urine by filtration, centrifugation or ether
These particles are not visible on microscopic examination
Fat GlobulesUsually give a milky appearance to urine
Confirmed on microscopic examination and can be removed by ether.

CCC Differential Diagnosis Series

NEURO

Anosmia, Ataxia, Blepharospasm, Bulbar and Pseudobulbar palsy, Central Pontine Myelinosis, Cerebellar Disease, Chorea, Cranial nerve lesions, Dementia, Dystonia, Exophthalmos, Eye trauma, Facial twitches, Fixed dilated pupil, Horner syndrome, Loss of vision, Meningism, Movement disorders, Optic disc abnormality, Parkinsonism, Peripheral neuropathy, Radiculopathy, Red eye, Retinal Haemorrhage, Seizures, Sudden severe headache, Tremor, Tunnel vision

RESP

Bronchial breath sounds, Bronchiectasis, High airway pressures, Massive haemoptysis, Sore throat, Tracheal displacement

CVS

Atrial Fibrillation, Bradycardia, Cardiac Failure, Chest Pain, Murmurs, Post-resuscitation syndrome, Pulseless Electrical Activity (PEA), Pulsus Paradoxus, Shock, Supraventricular tachycardia (SVT), Tachycardia, VT and VF, SVC Obstruction

GIT

Abdominal distension, Abdominal mass, Abdominal pain, Asterixis, Dysphagia, Hepatomegaly, Hepatosplenomegaly, Large bowel obstruction, Liver palpation abnormalities, Lower GI haemorrhage, Malabsorption, Medical causes of abdominal pain, Rectal mass, Small bowel obstruction, Upper GI Haemorrhage

GUT

Genital ulcers, Groin lump, Scrotal mass, Urine colour, Urine Odour, Urine transparency

MSK

Arthritis, Shoulder pain, Wasting of the small muscles of the hand

DERM

Palmar erythema, Serious skin signs in sick patients, Thickened Tethered Skin, Leg ulcers, Skin Tumour, Acanthosis Nigricans

ENDO

Diabetes Insipidus, Diffuse Goitre, Gynaecomastia, Hirsutism, Hypoglycaemia, SIADH, Weight Loss

HAEM

Splenomegaly

PAEDS

Floppy infant 

MISC

Anaphylaxis, Autoimmune associated diseases, Clubbing, Parotid Swelling, Splinter haemorrhages, Toxic agents and abnormal vitals, Toxicological causes of cardiac arrest

IMAGING

CHEST: Atelectasis, Hilar adenopathy, Hilar enlargement on CXR, Honeycomb lung, Increased interstitial markings, Mediastinal widening on mobile CXR, Pulmonary fibrosis, Pseudoinfiltrates on CXR, Pulmonary opacities on CXR,
ABDO: 
Gas on abdominal X-ray, Kidney mass,
BRAIN: 
Intracranial calcification, Intracranial structures with contrastVentriculomegaly,
OTHER: Pseudofracture on X-Ray

LABS

LOW: Anaemia, Hypocalcaemia, hypochloraemia, Hypomagnesaemia

HIGH: Bilirubin and Jaundice, HyperammonaemiaHypercalcaemia, Hyperchloraemia, Hyperkalaemia, Hypermagnesaemia

ACID BASE: Acid base disorders, Resp. acidosis, Resp. alkalosis,

Creatinine, CRP, Dipstick Urinalysis, Laboratory Urinalysis, Liver function tests (LFTs), Pleural fluid analysis, Urea, Urea Creatinine Ratio, Uric acid, Urinalysis, Urine Electrolytes


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CCC 700 6

Critical Care

Compendium

BA MA (Oxon) MBChB (Edin) FACEM FFSEM. Emergency physician, Sir Charles Gairdner Hospital.  Passion for rugby; medical history; medical education; and asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | Twitter |

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