— Situation study highlights relevance of proper urine sample storage
by Kristen MonacoSenior Staff Author, MedPage Today February 7, 2024
A person patient had many false constructive toxicology assessments right after getting a popular diabetic issues drug.
In spite of not ingesting alcoholic beverages for around ten months, a man in his early 60s examined constructive for ethanol in his urine on the last four urine samples he supplied a probation business office. None of the urine samples contained any traces of illicit or non-recommended substances.
But after contacting up his key care supplier for anxiety of going to jail above the constructive assessments, the principal treatment provider’s lab observed no detectable ethanol in a new urine sample, Aaron L. Schwartz, MD, PhD, of the Corporal Michael J. Crescenz Division of Veterans Affairs Health care Centre in Philadelphia, thorough in a New England Journal of Drugs correspondence.
Although they did not obtain ethanol on the repeat urine check, the principal care lab did obtain glycosuria current — an expected finding as the affected person was newly approved 20 mg day-to-day of the SGLT2 inhibitor empagliflozin (Jardiance) just five months prior for his diabetes.
This led Schwartz to call up the city probation business office to ask about specifically how they go about storing urine samples. In response, he was instructed that urine samples were being sent after daily to an exterior laboratory to be analyzed, but samples have been not refrigerated prior to transportation.
To examination a concept, the major care business office took their new urine sample out of refrigeration. A single day afterwards they retested the urine for ethanol soon after it remained at place temperature for 24 hrs. Now, the sample tested optimistic for ethanol.
“It appears to be this treatment induced my individual to have favourable urine assessments for alcoholic beverages even though he wasn’t ingesting alcoholic beverages,” Schwartz told MedPage These days. “This appears to have took place due to the fact the medication raises the volume of sugar and microbes in the urine. Microbes can change sugar into alcohol in the exact way that grape juice turns into wine.”
“When I approved this medicine for my patient’s diabetic issues, I hardly ever imagined it could bring about this harm,” he said.
He explained how the SGLT2 inhibitor class of agents makes glycosuria even when blood glucose levels are inside the standard array and also improves the presence of microbes in the urinary tract — two components needed for microbial fermentation.
Soon after the beneficial ethanol tests at the metropolis probation centre, the urine sample collected by the most important treatment facility three times later on experienced a glucose amount of 1,000 mg/dL. It was damaging for urinary ethanol, urinary ethyl glucuronide, leukocyte esterase, nitrites, ketones, blood, and bilirubin. A urine culture confirmed much less than 50,000 CFU/mL of mixed gram-favourable organisms.
“In this circumstance, the collection and storage of urine samples by the criminal justice technique appears to have been inadequate for ensuring specimen balance,” Schwartz pointed out.
“I hope there is a bigger consciousness of this achievable phenomenon amid clinicians,” he ongoing. “Toxicology tests for illicit medication and alcoholic beverages can be large stakes for individuals, both equally in the prison justice technique and the professional medical technique.”
He added that given that the class of SGLT2 inhibitors — which incorporates many others like dapagliflozin (Farxiga), canagliflozin (Invokana), and ertugliflozin (Steglatro) — are often prescribed for a broad-variety of diabetic issues, kidney, and cardiovascular indications, this could have the opportunity to affect a whole lot of sufferers.
“I would really encourage clinicians to be conscious of no matter whether a affected individual is topic to urine toxicology tests when using this treatment,” Schwartz advisable. “A clinician must be rather skeptical of positive tests in these circumstances.”
Kristen Monaco is a senior employees writer, focusing on endocrinology, psychiatry, and nephrology news. Centered out of the New York Town business, she’s labored at the organization considering that 2015.
Schwartz described relationships with Aetna, the Lauren and John Arnold Foundation, Lown Institute, Medicare Payment Advisory Fee, Tufts Professional medical Centre, U.S. Agency for Global Improvement, VBID Overall health, and the Veterans Wellness Administration.
New England Journal of Drugs
Source Reference: Schwartz AL “SGLT2 inhibitors and phony favourable toxicology assessments” N Engl J Med 2024 DOI: 10.1056/NEJMc2313463.