How to Use This Guide
Use this as a quick interpretation aid for ward / ED dipsticks. Always correlate with history, exam and microscopy/culture. “Red flags” like blood, protein and bilirubin often need formal follow-up.
Classic UTI pattern: leukocytes and nitrites positive UTI likely – send urine for MC&S and treat according to local protocol.
Urine Dipstick Parameters & Interpretation
| Parameter | Normal | Abnormal Finding | Common Causes / Next Steps |
|---|---|---|---|
| Leukocytes | Negative | Positive |
UTI, contamination, inflammation anywhere in urinary tract. » Check nitrites, symptoms, pregnancy status. » Send urine for MC&S if symptomatic or high-risk. |
| Nitrites | Negative | Positive |
Gram-negative bacteriuria (e.g. E. coli). » Strongly supports UTI if leukocytes/symptoms present. » Send MC&S; consider empiric antibiotics per local guideline. |
| Urobilinogen | ~0.2–1.0 mg/dL | Increased / Decreased |
Increased: hemolysis, hepatocellular disease. Decreased/absent: possible obstructive jaundice. » Check LFTs, FBC, bilirubin; consider abdominal US. |
| Protein | Negative / trace | + to +++ |
Glomerular disease, UTI, fever, strenuous exercise, pre-eclampsia, HTN, diabetes. » If persistent: U&E, ACR/PCR or 24-hr protein; consider renal US and referral. |
| pH | 4.5–8.0 | High or low |
Alkaline: urea-splitting UTI, vomiting, RTA, vegetarian diet. Acidic: metabolic acidosis, DKA, diarrhoea, high-protein diet. » Correlate with ABG, electrolytes, clinical picture. |
| Blood / Hb | Negative | Trace to +++ |
Stones, UTI, trauma, malignancy, GN; can also pick up myoglobin (rhabdo) or haemolysis. » Confirm with microscopy (RBCs), consider imaging and urology/renal follow-up. |
| Specific Gravity | 1.005–1.030 | High or low |
High (>1.020): dehydration, SIADH, HF, concentrated urine. Low (<1.010): overhydration, DI, impaired concentrating ability (CKD). » Check fluid status, U&E, consider serum/urine osmolality if unclear. |
| Ketones | Negative | Positive |
DKA, starvation, low-carb diet, prolonged vomiting, pregnancy hyperemesis. » Check capillary glucose, VBG/ABG, β-hydroxybutyrate, pregnancy test where relevant. |
| Glucose | Negative | Positive |
Diabetes, stress hyperglycaemia, renal glycosuria. » Check random/fasting glucose, HbA1c; consider OGTT if unclear. |
| Bilirubin | Negative | Positive |
Conjugated hyperbilirubinaemia: hepatocellular disease, cholestasis/obstruction, some drugs. » Check LFTs, ultrasound; review for jaundice, pruritus, pale stools, dark urine. |
Remember: Dipsticks are a screening tool. False positives/negatives are common. In the ED, abnormal results that don’t fit the story should prompt repeat testing, microscopy or formal lab workup.