Urine testing

NurseJackie69 · Apr 12

Depends on what monitoring test contractor you have. Affinity, Recovery Trek, etc?

Here is how Affinity is Reported.

When the creatinine is < 20, the lab automatically runs a specific gravity test as another measure of concentration. Specific gravity > 1.003 with creatinine < 20 is reported as ABNORMAL. Specific gravity between 1.001 and 1.003 with creatinine < 20 is considered DILUTE. Specific gravity <1.001 is physiologically not possible in humans. Both abnormal and dilute tests are significant and further testing is indicated.

If you are with Affinity, your results are concerning because there is a Difference in "Dilute" and "Abnormal." Abnormal refers to your specific gravity being in normal range, but your Creatinine is low, so this is concerning. If your results are positive for alcohol, Etg, they would be reported as Positive. The reason your sample is Not labeled Dilute instead of Abnormal is because you didn't have BOTH a low creatinine and a low Specific Gravity. You have a Specific Gravity within normal range, but a Low creatinine. This can be caused by 3 things. Overhydration (too much water) can still cause the specific gravity to barely be normal, but just enough to drop the creatinine level to being to low and this is the most common reason. The 2nd thing is substitution or tampering (2nd most common reason). The 3rd thing (3rd most common reason) is medications you take that interview with production of creatinine levels, and or you have very low muscle mass, not so great nutrition, so you don't produce much creatine. Additionally, liver disease, but usually needs to be severe, can cause low creatinine levels, but normal specific gravity.

With all the above written about Affinity. There is Recovery Trek. Recovery Trek will generally report ANY result that is not NORMAL as "Abnormal" until the Medical Review Doc investigates (calls you, goes over meds you are taking as prescribed, etc) and they go from there. For example, after the MRO's review, the result is changed to Dilute-Negative (Diluted Specimen but no drugs present) or Dilute-Positive, or Adulterated or Substituted, etc. So, in Recovery Trek, the initial result can be "Abnormal" for basically any outcome except for a Normal Result, and then it's changed from Abnormal to some of the examples listed above after the MRO is completed.

In summary, the most likely cause of your "Abnormal" Result has resulted in overhydration, too much water. The 2nd most likely cause is you purposely tampered, did something to throw off the test (and I'm NOT saying you did). I'm saying these causes are the most common in this order around the country when an Abnormal sample is reported. The 3rd most common cause (again, I'm NOT saying you have this) is decreased muscle mass (you don't produce much creatinine to start with because you have very low muscle mass), significant liver disease, OR you are taking a medication that actually can lower Creatinine levels such as cimetidine, cobicistat, dolutegravir, fenofibrate, ritonavir, or trimethoprim.

You also asked if the BON will consider your result "positive." Scarlet70, you do realize there are 50 BON's in the USA? You didn't list which Board, so there is no way to give you an answer. The "Board" in Idaho isn't the same as the "Board" in Alabama and it's not just "The Board," it's also about your Monitoring Program who is usually the first step and often the final step as to whether your Monitoring Program notifies the BON. The Monitoring Program and your case manager has lots of power and if truly were overhydrated and drank to much, then say that and stick with it and be convincing, remorseful, and apologetic to your case manager and in most of these cases, it doesn't advance to the level of the BON, but stays at the level of the Monitoring Program. Obviously, if it happens over and over, the Monitoring Program notifies the BON. Now, I don't know, but keep in mind this and I am NOT saying you tampered. This is for anyone reading. If you did tamper, they can tell. For example, if your specific gravity is Normal and on the low side of normal, and your creatinine is barely, barely low, it's likely its simply overhydration and they know this. They can tell this. IF your creatinine is very, very low and your specific gravity is perfectly normal or even on the high side of normal, those are overwhelming red flags and basically, they are a given for tampering.

In summary, what's likely happened and this happens Most of the times in these situations. You overhydrated. Your specific gravity is Barely within normal range by a thin, thin margin, and your Creatinine is Barely, by a thin margin, just below 20 (low). This is classic overhydration and for most Monitoring Programs and BON's, you get told to be careful, don't overhydrate and watch what you are doing and if it happens again, your testing increases and/or the BON gets notified.

Scarlet70 · Apr 12

Thank you

Healer555 · Apr 12

Where I am if it's dilute they send us instructions on how to make it less likely to be dilute and we get a few more chances. If you have a medical reason why it's dilute see a physician and get a doctors note. We don't get in trouble for a few dilute urine where I am. It depends on the state and the medical director. Drinking a protein shake tge day of testing can help

Scarlet70 · Apr 12

Thank you. I do have a medical condition that involves metabolizing protein and all kinds of stuff. Plus I had a hard physical therapy session related to my knee replacement.

Healer555 · Apr 12

Scarlet70 said:

Thank you. I do have a medical condition that involves metabolizing protein and all kinds of stuff. Plus I had a hard physical therapy session related to my knee replacement.

I'd make an appointment with those providers ,we have to see physicians for these letters. If it may be a continued issue and it sounds like it may be, you can request alternative testing. I can't do the observed urine tests so o blood test. I had to see a psychiatrist to get a letter stating that. I got lucky to get an appointment for that quickly. I think they gave me 2 weeks to get the letter. Really stupid IMO. I told the monitoring agency I couldn't pee in front of people and that wasn't good enough so I paid to tell a psychiatrist that. Total waste of time and money

PaddedCellLPN, LPN · Apr 15

I had an issue with this when I first started. I keep applying pack of slim Jim's and ensure high protein in my locker at work for test days. I go at lunch, so I make sure I have a slim jim and an ensure about 8 am. It stopped the dilutes.