Abnormal Urine Specific Gravity (Nursing)

00:00 Hi, welcome to our video series on interpreting lab values.

00:04 In this one, we're going to take a look at the causes of high urine specific gravity.

00:09 Now as a quick review, urine specific gravity is comparing the density of a substance to another substance, it's a ratio.

00:17 In the case of urine specific gravity, we're comparing urine to pure water.

00:23 Now the density of water is 1.00.

00:27 The normal urine specific gravity is 1.010 to 1.030.

00:32 Speaking of urine, I've got five bladders up there for you.

00:36 And you see they all have a letter A, B, C, D, and E.

00:41 So this is kind of give you a rainbow spectrum view of what you might see as a nurse when you're evaluating the color and the clarity of a patient's urine.

00:51 So look at the difference between A and B.

00:54 Notice how it changes as we move through to C, D, and E.

00:58 Now, we have the reasons there that your urine can be those different colors.

01:03 Remember, the more dehydrated you are the darker the urine will appear.

01:08 Let's say you have a urine specific gravity of 1.020.

01:13 Okay, so your patient's urine specific gravity is 1.020.

01:19 Which bladder would you say best represents that urine specific gravity? We have to ask yourself, what is normal? I guess, 1.010 to 1.030.

01:32 So it's within a normal range.

01:34 All right, it's kind of in the middle.

01:37 So which bladder do you think represents that? Yeah, probably B or C, right? That's probably about what it would look like.

01:44 It definitely would not be A.

01:46 Probably somewhere in between B and C would be the best answer.

01:51 Okay, now, why do we have bladders up there for you? Because good old fashioned nursing assessment saves lives.

01:59 We have all kinds of fancy tools in critical care, ICU, and the ER's. And we all love to play with those.

02:06 But I'm telling you understanding the basics of assessment, if you can look at somebody's urine, if you can look at a basic CBC, we can learn a lot about a person's body and how its functioning.

02:19 So assessment saves lives, period.

02:23 I can have somebody who has lots of toys if they don't understand basic assessment, their patients are going to suffer.

02:29 So this is worth your time to sit back with us and invest the time in understanding the changes in a patient urine.

02:36 Because abnormal values mean an imbalance in fluid status, period.

02:42 If I have an abnormal urine specific gravity, there's some fluid imbalance going on.

02:49 That means my body has less onboard that it needs or more on board than it can handle.

02:55 Now, diseases can cause this or inappropriate fluid intake And we have some patients that sometimes have because of a psychological disorder, they have this incredible insatiable thirst.

03:08 And they will drink, and drink, and drink, and drink, and drink, and drink, and drink, and drink, and drink, and drink and drink, and drink, and drink.

03:13 It is scary to see because what they end up doing is taking in all this fluid volume, and they ended up diluting their serum sodium.

03:22 So that would be an example of an excessive intake that's an awake, and alert person who can walk themselves to a water bottle and drink it.

03:30 We're not talking about somebody in a bed.

03:33 We can also have inappropriate fluid intake for somebody in a hospital setting.

03:37 We give them too much IV fluid, any number of things because sometimes the body is limping along and we don't recognize it quick enough, and we can overload them.

03:48 So keeping in mind, if I have an abnormal value, it's time to start asking why, looking at the patient's history, asking the right assessment questions because we can really harm a patient if they don't get enough fluid or if they get too much fluid, That's why I always tell my students, "Hey, there is no such thing as a perfectly safe bag of IVs." So even if you've got 0.9% normal saline, when you go to hang that bag, I hope you see my beady little face looking back at you, and you hear my squawking voice saying, "There is no such thing as a perfectly safe IV fluid, because you're messing with a patient's fluid volume status." So be careful when you're administering IV fluids or any other fluids to your patient.

04:35 See, we're going to probably take some further testing if the urine specific gravity is off enough, we're going to look at some other tests to make sure there isn't a heart problem or there isn't a renal problem, or there's not some type of metabolic disorder like diabetes insipidus or SIADH, which is syndrome of inappropriate antidiuretic hormone.

04:58 Okay, so abnormal specific gravity, the more dehydrated patient is, the higher the specific gravity number will be.

05:05 You've got the normal values there, as I'm moving down, you've got 1.025 and then greater than 1.030.

05:16 Now normal urine is going to hit right there between 010 and 030.

05:21 As the urine becomes more concentrated, you're going to be moving upwards towards 025, that's still a normal value, but that urine is going to become more concentrated.

05:33 Now, greater than 1.030 is definitely concentrated.

05:38 But that middle value, remember it's a spectrum.

05:42 So that urine isn't becoming more dilute, it's becoming more concentrated as we move towards 1.030.

05:50 So you know, this is my favorite part.

05:52 Let's apply it to patient care.

05:54 We've got Ms. Hydrashun.

05:55 Their urine specific gravity is 1.035.

06:00 Is that result high, low, or normal? Right, this result is high.

06:08 Now, if I was going to look at Ms. Dee Hydrashun urine, what would I expect to find? Which one of these bladders would be most likely what her urine would look like? Remember, the more dehydrated the patient is the higher the specific gravity will be.

06:22 So where would you identify as the most likely color of Ms. Dee Hydrashun urine? Yeah, I would say with that.

06:32 We're probably in between the third and fourth bladder somewhere along there.

06:36 I'm definitely not going to expect it to look like that first bladder, or as pale, straw, and well hydrated.

06:42 Because I know that this number is higher.

06:44 This indicates dehydration.