Non-blood Specimen (Urine & Stool)

• Characteristics of a urine specimen

  • Readily available and easily collected
  • Urine contains information about many of the body's major metabolic functions
• Urinalysis


  Testing of urine with procedures commonly performed in an expeditious, reliable, safe, and cost-effective manner
• Urine specimen collection


  • Non-invasive
• Reasons for urinalysis


  • Disease diagnosis
  • Screening asymptomatic populations for undetected disorders
  • Monitoring progress of disease and effectiveness of therapy
• Urine formation


  • Ultrafiltrate of Plasma or Blood
  • Formed at Kidneys
  • Average Daily output is 1200 mL 1500 mL
• Terminologies related to urine output

  • Normal Daily Output – 1200-1500mL (600-2000mL also considered normal)
  • Oliguria – Decreased Urine Output: 400mL/day (Adults); Occurs at excessive water loss (diarrhea, excessive vomiting, burns, dehydration)
  • Anuria – cessation of urine flow suggests severe kidney damage (obstruction or infection)
  • Nocturia – increased excretion of urine during the night
  • Polyuria – increased Urine Output: >2.5L/day for adults (diabetes)
• Urine composition


  Urine is normally 95% water and 5% Solutes (Organic and Inorganic)
• Organic solutes in urine (24-hour specimen)


  • Urea (25.0-35.0g) – 60-90% Nitrogenous material (protein metabolism)
  • Creatinine (1.5g) – Derived from creatine (muscle metabolism)
  • Uric acid (0.4-1.0g) – Common component of Kidney Stones (purine metabolism)
  • Hippuric acid (0.7g) – Derived from Benzoic Acid (metabolism of benzoic acid)
  • Others (2.9g) – other protein, carbohydrates, and fatty acids
• Inorganic solutes in urine (24-hour specimen)


  • NaCl (15.0g) – Principal salt
  • Potassium (3.3g) – Occurs as chloride, sulfate, phosphate salts
  • Sulfate (2.5g) – Derived from amino acids
  • Phosphate (2.5g) – Serves as buffers in blood
  • Ammonium (0.7g) – Derived from protein and glutamine metabolism
  • Magnesium (0.1g) – Occurs as chloride, sulfate, phosphate salts
  • Calcium (0.3g) – Occurs as chloride, sulfate, phosphate salts
• Urine is classified as a BIOHAZARD
• Observe Standard Precautions
• Requisition Forms are required
• Containers for routine urinalysis

  • Clean and Dry (Sterile)
  • Leak Proof
  • Screw top lids
  • Should have a wide mouth
  • Made of clear material
  • Recommended capacity: 50mL
  • Labelled. (Attached to CONTAINER, not the lid)
• Types of urine specimens

  • Random
  • First Morning
  • 24-Hour Specimen
  • Suprapubic Aspiration
  • Catheterized
  • Midstream Clean-Catch
• Purpose of different urine specimens

  • Random - Routine screening
  • First - Monitoring routine screening, pregnancy test, orthostatic protein
  • Fasting - Diabetic screening/monitoring
  • 24-hour (or timed) - Quantitative chemical tests
  • Catheterized - Bacterial culture
  • Midstream clean-catch - Routine screening, bacterial culture
  • Suprapubic Aspiration - Bladder urine for bacterial culture, cytology
• Urine drug sample collection


  • Sample collection is the most vulnerable part of Drug Testing
  • Phlebotomist must ensure that no tampering of the specimen was done by the patient
  • Types of tampering: Adulteration, Substitution, Dilution
  • Chain of Custody - Documentation of Sample Handling
  • May be "Witnessed" or "Unwitnessed"
  • 30-45mL of Urine is collected
  • Temperature, pH, Color and Specific Gravity of Urine will be tested immediately
  • Ideal Temp (32.5-37.7°C)
  • Urine pH of greater than 9 suggests adulteration or old specimen
  • Specific Gravity less than 1.005 suggests dilution
  • Bluing dye is placed on toilets to prevent patients to use toilet water to dilute specimen
• Urine preservatives


  • Refrigeration (2-8C) - Doesn't interfere with chemical tests, Raises Specific Gravity, Precipitates Urates and Phosphates
  • Toluene - Doesn't interfere with routine test, Floats on surface of specimens and clings to pipettes and testing materials
  • Sodium fluoride - Ideal for Drug Testing, Inhibits Reagent Strip Tests
  • Formalin - Preserves Sediments, Interferes with Chemical Tests
  • Phenol - Doesn't interfere with routine test, Causes Odor Change (more alkaline)
• Specimen should be delivered and tested within 2 hours
• Fecal specimen analysis


  • Helpful in the evaluation of gastrointestinal disorders
  • Evaluated for the presence of intestinal parasites and their eggs (ova and parasites, or O&P)
  • For detection of fats and urobilinogen content
  • Cultured to detect the presence of pathogenic bacteria (e.g., C. difficile and Salmonella) and viruses
  • Tested for the presence of occult (hidden) blood using the guaiac test
  • Kits containing reagent impregnated filter paper are provided to screen for the presence of occult (hidden) blood
  • The patient is usually instructed to follow a meat free diet for 3 days prior to the test
  • Patients are then instructed to collect separate specimens for 3 successive days