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Urine osmolality - is this reference range right?

Discussion in 'Gastrointestinal and Urinary' started by picante, Jun 20, 2016.

  1. picante

    picante Senior Member

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    I just got the results of a 24-hour urine osmolality test"
    Osmolality, Urine: 250.0 mOsmol/kg [ 0 - 289.9]

    That range can't be right, can it?
    A quick search tells me the range is usually 300-900 or 500-800 milli-osmoles / kg.

    I took in 111 oz. (3282 ml) of fluids that day and peed out more than that: I filled a 4-liter container to the brim.
    That was the minimum I could drink and not feel constant thirst. I was dehydrated by evening, which tells me that I usually drink more. The greatest amount I peed at one go was 2/3 quart, around 2 or 3 am.
     
  2. barbc56

    barbc56 Senior Member

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    I've had about three 24 hour urine tests over the last two years. Fun isn't it?

    What I didn't realize is that your age as well as your diet can affect the "normal" range. A lot of my results said "range is not established for those over 60" or "range depends on diet." which is quite confusing. I would ask your urologist about these. It's often recommended that you get two tests for accuracy as there are so many things that can degrade the urine.

    Also a 24 hour urine tests can differ as far as what is tested. You want to make sure you get a complete testing. My first one only tested for a few things. I can't remember what was left out of my first one but it's something to bring up with your physician.

    Good luck!

    Edit. What you find on the internet may be measured in different units and the information may not be accurate. Different labs may use different units or even different ranges. One item tested may or may not carry as much weight as the other items tested.:confused:
     
    Last edited: Jun 20, 2016
    picante likes this.
  3. picante

    picante Senior Member

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    Thanks, @barbc56. Urine osmolality was the only thing tested. That's all my ND ordered, after he looked at ADH and Hemoglobin A1C.

    So would the range be different with age, does anyone know? I'm 59.
     
  4. Jonathan Edwards

    Jonathan Edwards Senior Member

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    As far as I remember the urine osmolality is only really helpful taken together with plasma osmolality. If you have a high fluid intake - and it sounds as if you do - then the urine osmolality will be lower than average. If you drink large amounts of fluid urine osmolality has to be low to get rid of the fluid without getting rid of sodium. I suspect most people take in 1.5-2.0 litres of drinks a day (in addition to the fluid in food which might be another litre).
     
    picante likes this.
  5. barbc56

    barbc56 Senior Member

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    Hi @picante

    I am not a doctor so keep that in mind. If you feel comfortable answering this, why are you getting the test? You can also send me a PM.

    Depending on why you are getting this test, may make a difference. I'm quite
    surprised this was the only thing measured. My recommendation would be to possibly see a urologist or nephrologist, if your doctor is looking for a kidney condition. He/she may have a good reason for only testing the Osmolality.

    I am now seeing another urologist and a nephrologist..The doctor I'm seeing, actually it's a team approach, is an expert in the latest information. I won't go into detail as my condition may be completely different than yours. There may be another reason you only had this tested.

    Again, PM me if you want. If you're in the states, I can give you some recommendations for a doctor as mine has a list of doctors all around the country he works with and some have done studies with him. him. They are scattered around the country.

    If you are not in the states I can tell you what strategies I used to get the second urologist.It was a lot of work and it would have been helpful to know some shortcuts when appropriate.

    Ah, I see you are in the states.
     
  6. picante

    picante Senior Member

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    I have polyuria. It seems pretty common on this forum. I drink because I'm thirsty because water is not staying in my body. I have no tolerance whatsoever for alcohol.

    I live at 4200' in the Rockies, and every time I go to the coast I gain 5-6 pounds in water. And I feel better. It takes about 2 days to lose that water weight when I come home. Without trying, it just goes away.

    In the past, I've had aldosterone checked (but not recently). It was mid-range. Recently, my ND has looked at my blood sugar. It has always been 60 fasting, and 80-85 non-fasting. Always. I have chronic hypoglycemia. I eat all day. And in the middle of the night.

    I get to use the state employees' health clinic here. They ordered hemoglobin A1C and ADH
    ADH: 0.8 pg/mL [0-4.7]
    Hemoglobin A1C: 5.50% [4.8-5.6]
    They said hemogobin A1C and anti-diuretic hormone were normal, so they didn't want to testing fasting insulin. I kind of think that ADH is low, but apparently they think it's normal until it's below zero. :whistle::rolleyes:

    The PA at the clinic says I should go see an endocrinologist for further tests. You're thinking a urologist/nephrologist. I don't know who to go to.

    There's another hormone/cytokine I suspect: leptin. But my ND didn't want to order the test. Leptin fluctuations would affect blood sugar, wouldn't they? And would that in turn affect urine output?

    FYI I think my debilitating neck pain is from cytokines. My onset was viral (EBV), and it appears that it was meningitis, from the symptoms. The Urgent Care docs didn't catch that. And they only tested for mono at my insistence. This was 24 years ago.

    My recent experience with a Byron White formula is here: http://forums.phoenixrising.me/inde...-have-questions-about-cytokines-leptin.44984/
    No one answered -- I suspect they're all scratching their heads, just like me. :confused: I've stopped the Vinpocetine now.
     
  7. picante

    picante Senior Member

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    Jonathan, would they have to be taken at the same time? And would that be a 24-hr urine or a random sample?
     
  8. barbc56

    barbc56 Senior Member

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    I would listen to your NP when it comes to what kind of specialist since more familiar with your health.

    It sounds like what I have is not related to what you have.

    Take care and good luck!
     
    picante likes this.
  9. Jonathan Edwards

    Jonathan Edwards Senior Member

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    You would need to ask the endocrinologist. I agree that this sounds like a problem for an endocrinologist. Again, ADH would I think be lowish if you have a high fluid throughput. It would be abnormal to be low during water deprivation.

    It does not sound to be anything to do with anything documented in ME/CFS as far as I am aware.
     
    picante likes this.
  10. halcyon

    halcyon Senior Member

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    Violeta, picante and Sidereal like this.
  11. Jonathan Edwards

    Jonathan Edwards Senior Member

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    If that is all there is out there Halcyon I am not impressed. There are no actual data in the abstract and it seems highly likely that they studied some patients they already had some reason to think had water retention anyway. There is no suggestion of an actual DH control abnormality having been demonstrated in the abstract.
     
    picante likes this.
  12. picante

    picante Senior Member

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    I have water loss, not retention. But that's interesting about serum vs. urine osmolality.
     
  13. Violeta

    Violeta Senior Member

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    @picante I have polyuria, too. I just found this information about Vitamin C possibly helping. I find the sodium ascorbate form helps the most. But I do have other signs of Vitamin C deficiency. Perhaps this has something to do with postviral onset that was mentioned in another post.

    http://www.ncbi.nlm.nih.gov/pubmed/26612352

    Ascorbate-dependent vasopressor synthesis: a rationale for vitamin C administration in severe sepsis and septic shock?
     
    picante likes this.
  14. Violeta

    Violeta Senior Member

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    @picante has your ND mentioned nephrogenic diabetes insipidus? I see it can be caused by hypercalcemia.

    "Most often hyperparathyroidism is diagnosed prior to the development of symptoms. Typically when symptoms of hyperparathyroidism do occur, the symptoms presented are the result of damage or dysfunction in the affected organs and tissues. Symptoms of hyperparathyroidism range in severity but commonly include fragile bones, kidney stones, excessive urination, abdominal pain, weakness, fatigue, depression, forgetfulness, bone and joint pain, frequent illness and gastrointestinal issues."
    http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/endocrinology/hypercalcemia/

    I'm not thinking along the terms of parathyroid tumor and anything that severe, but I am wondering if parathyroid dysregulation could be at the root.

    http://www.ncbi.nlm.nih.gov/pubmed/1882251

    http://emedicine.medscape.com/article/117648-workup
     
    Last edited: Jul 25, 2016
  15. picante

    picante Senior Member

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    Hi Violeta, not yet, but I'm going to see him in an hour. Here's what I don't understand about diabetes insipidus: does your blood glucose go high? I got a glucose meter to check mine 20-30 minutes after meals, and it never goes very high. All my lab tests show low fasting blood glucose (60) and all the labs taken 1-2 hours after eating have been in the 80s.
     
  16. Violeta

    Violeta Senior Member

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    No, blood sugar isn't involved in this type of diabetes. Good blood sugar! Good for you. Have you had blood calcium levels checked?
     
  17. Gondwanaland

    Gondwanaland Senior Member

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    I am pretty sure I had hyperinsulinemia when I had polyuria. No doctor ever checked it. All they could do was to prescribe abx despite negative bacteriological urine results :mad:
     
  18. picante

    picante Senior Member

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    My lab results follow:
    Serum calcium is always between 9.6 and 10.0 mg/dL [8.7-10.2] and that's with no supplemental Ca.

    May 2012 Parathyroid, intact 23 pg/mL [15-65]
    May 2012 Calcium (ionized) 5.1 mg/dL [4.5-5.6]
    May 2016 ADH 0.8 pg/mL [0-4.7] (Ahem. Zero is within range?!! Are they including dead people?)
    June 2016 Osmolality, Urine: 250.0 mOsmol/kg [ 0 - 289.9] which my ND says is LOW, and they must have screwed up on the range, which usually starts at 300.
    Since I have polyuria, I take a lot of potassium, because I pee a lot out. My blood levels always look normal.

    The only thing he measured today was urine specific gravity, and I don't have that result yet. Since I have an appointment with the endocrinologist in a week, he didn't order anything else.

    So he also wonders about diabetes insipidus, but my guess is it would be neurogenic if I do have it.
     
  19. picante

    picante Senior Member

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    How frustrating. Can you tell me why you think you had hyperinsulinemia? And how I might persuade the endo to test insulin?
     
  20. Gondwanaland

    Gondwanaland Senior Member

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    Well my diet was full of whole grains at that time, I had NAFLD, high triglycerids. After going gluten free all those symptoms disappeared incl polyuria (which came back later due to some stupid things I did like taking garlic oil for detox :bang-head: )
    About persuasion... I don't know, you can argue that your test results haven't helped your health so far and that you need an OGTT + insulin assay to try to see what is going on ...
     

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