A Day in the Life of a Urine Sample
Transcription
A Day in the Life of a Urine Sample
!"#"$#% A Day in the Life of a Urine Sample David J. Kuntz, PhD, DABFT Executive Director of Analytical Toxicology Clinical Reference Laboratory Lenexa, KS 66215 email | kuntzd@crlcorp.com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`U%(+':/939'U%:9B%7H3B:9)1% ! ?<(757<%:9B%% ! F)I% ! O:+-3)*+:)'1U%-'9E7B3:E'639'1U%7HD(7B79'U% ;')5:B79'U%6+767HD65'9'U%;')5:X*:<79'% ! O*6+'97+6539'% ! C:+316+7B7<%\>7;:]% >aA% >6'(3;'9%a:<3B3)D%A'1/9=% ! >6'(3;'9%0:<3B3)D%)'1)%:11:D1b% ! C+':/939'%\:*)7;:)'B%:9:<DE'+]%% ! 6`%\:*)7;:)'B%:9:<DE'+%:9B%6`%;')'+]% ! >6'(3G(%I+:03)D%\+'8+:()7;')'+]% ! ,H3B:9)%(79G+;:/79%\93)+3)'%:9B%37B:)'%-D%379% (5+7;:)7=+:65D]% ! C79G+;:/79%+'X*3+'1%:%1'(79B%:<3X*7)%87+%:<<%:11:D1% ! >6'(3G(%+'X*3+';'9)1%87+%':(5%)'1)%87+%+'67+/9=%78% @ca?&@K%7+%?Kd&AF2?AFK% % _% !"#"$#% F&@>?%>(+''939=%87+% ?<)'+9:/0'%K+*=1% ! O+7:B'+%6:9'<1%78%B+*=1%;*1)%-'%:9:<DE'B%*139=%:9% :<)'+9:/0'%;')57B% ! F&@>?%6:9'<1%:+'%1<74'+%)7%6'+87+;%\79'%57*+% 39(*-:/79%/;']U%;7+'%(71)<D%39%+':='9)1%:9B%<:-7+U% ;*</1)'6%6+7('11%)7%7-):39%+'1*<)1% ! >'913/03)D%31%;*(5%53=5'+%)5:9%)+:B3/79:<%:9:<D131% 43)5%(5';31)+D%:9:<DE'+1% ! J':1*+';'9)%78%(7<7+%79%:%f_N4'<<%6<:)'%43)5%':(5% 4'<<%(7:)'B%43)5%:9/-7B3'1%87+%B')'(/79%78%)5'%B+*=%% e% !"#"$#% C79G+;:/79%FH)+:(/791% ! ?%1'(79B%*+39'%:<3X*7)%31%:<4:D1%+'X*3+'B%87+% (79G+;:/791% ! d+39'%-7Q<'%31%1(:99'B%)7%='9'+:)'%)5'%-:+(7B'%:66<3'B%)7% :%)*-'%87+%'H)+:(/791% ! 2'X*3+'1%hWZ%)7%S%;&%87+%IC"J>% ! 2'X*3+'1%<'11%)5:9%hWZ%;&%87+%&CJ>J>% ! @9)'+9:<%1):9B:+B%:9B%393/:<%+':='9)1%:BB'B% ! IC"J>%+'X*3+'1%'H)+:(/79%)7%+';70'%:9D%:X*'7*1% :9B%4:1)'%;:)'+3:<%:9B%)D63(:<<D%+'X*3+'1% B'+303/E:/79%78%)5'%B+*=%-'87+'%39.'(/79% g% !"#"$#% f% !"#"$#% IC"J>%C79G+;:/79% ! 2'X*3+'1%:%9'4%:<3X*7)%8+7;%-7Q<'% ! 2'X*3+'1%)5'%B+*="B+*=%;'):-7<3)'%)7%-'%'H)+:()'B% 8+7;%)5'%*+39'%:9B%6<:('B%39)7%:9%7+=:93(%17<0'9)%87+% IC"J>%% ! J*</N1)'6%6+7('11%+'X*3+39=%$%)7%!%57*+1%78%'H)+:(/79" 5DB+7<D131%/;'%)7%6+'6:+'%1:;6<'% ! @91)+*;'9)%38%)*9'B%B:3<D%39%6+'6:+:/79%78%)'1/9=W%% C:<3-+:)7+1%:9%(79)+7<1%:+'%*1'B%)7%'1):-<315% 3B'9/G(:/79%:9B%X*:9/):/79%78%)5'%B+*=%78%39)'+'1)% ! ?<<%1)'61%:+'%-:+(7B'B%)+:(M'B%% $h% !"#"$#% $$% !"#"$#% &C"J>"J>%FH)+:(/791% ! >:;6<'%;:D%-'%'3)5'+%B3<*)'B%7+%'H)+:()'B%6+37+%)7% 39.'(/79% ! >'913/03)D%31%:-7*)%$hhhN87<B%53=5'+%)5:9%)D63(:<%IC" J>%\<'11%1:;6<'%*1'B]% ! L+703B'1%)5'%)7H3(7<7=31)%43)5%;:9D%;7+'%76/791%87+% B+*=%B')'(/79%:9B%76/;3E:/79%78%;')57B% ! J:9D%;7+'%(7<*;9%)D6'1%)7%(5771'%8+7;%)7%76/;3E'% :9:<D131% ! >'913/03)D%31%53=5'+%)7%<77M%87+%;397+%B+*=%;'):-7<3)'1%% ! L+703B'1%87+%:9:<D131%78%43B'+%=+7*61%78%*9+'<:)'B% (7;67*9B1%39%:%139=<'%39.'(/79% ! c'=:/0'%8:()7+%31%(71)%78%391)+*;'9)% % &C"J>"J>%?9:<D131% ! @91)+*;'9)%31%(7;-39:/79%78%:%&3X*3B%C5+7;:)7=+:65%\&C]% :9B%)47%1')1%78%%X*:B+*67<'1%\J>"J>]% ! A5'%&C%:9B%:9:<D/(:<%(7<*;9%1'6:+:)'%)5'%B+*=%78%39)'+'1)% 8+7;%7)5'+%*+39'%(7;679'9)1% ! A5'%J>"J>%6+703B'1%)5'%B')'(/79%43)5%3791%1'<'()'B%39%i$U% 8+:=;'9)1%87+;'B%39%)5'%(7<<31379%('<<%\;3BB<']U%:9B%8+:=;'9)1% B')'()'B%39%iS% ! L+703B'1%53=5'+%16'(3G(3)D%:9B%;393;3E'1%39)'+8'+39=%*+39'% (7;679'9)1% ! j3<<%+'6<:('%IC"J>%:1%)5'%6+3;:+D%B+*=%B')'(/79%391)+*;'9)% ;7039=%87+4:+B%:1%3)%:^7+B1%;7+'%P'H3-3<3)D%87+%:9:<D131%:9B% B'0'<76;'9)%78%9'4%B+*=%:11:D1%\'W=WU%1D9)5'/(% (:99:-3973B1U%-:)5%1:<)1U%')(W]% % $S% !"#"$#% $#% !"#"$#% V39:<%K:):%2'03'4% ! ,9('%)'1/9=%31%(7;6<')'U%)5'%('+/8D39=% 1(3'9/1)%+'03'41%!""#$%&'()*+!+,%*# ! FH)'+9:<%CCVU%iCU%1(+''939=%T%(79G+;:/79% B:):%6+37+%)7%+'<':1'%)7%)5'%J2,%% ! FH)'+9:<%CCV%31%13=9'BU%B:)'BU%:9B%+'1*<)1% :997):)'B%6+37+%)7%3;:=39=%87+%'<'()+793(% )+:918'+%78%)5'%CCV%39%'<'()+793(%B749<7:B% V39:<%O7Q<'%K316713/79% ! O7Q<'1%87+%9'=:/0'%+'1*<)1%:+'%B'1)+7D'B% 43)539%Z%B:D1% ! L713/0'%1:;6<'1%:+'%8+7E'9%:9B%1:0'B%87+%$#% ;79)51%7+%;:D%-'%1)7+'B%39B'G93)'<D%43)5% +'X*'1)%87+%67)'9/:<%<3/=:/79% ! d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i*'1/791k% $Z%