A: From the time the specimen is collected in the office to when it was tested at the laboratory, the pH may have changed considerably. Over time, a bacterium hydrolyzes the urea in the urine specimen. One of the by-products of bacterial degradation of urea is ammonia, which increases the urine pH. The reference laboratory you mentioned should not have rejected the specimen even though the pH was 9.5. (Millennium Laboratories accepts specimens up to pH 9.5.) In this case, adulteration was unlikely.
A: Abnormally low creatinine and specific gravity levels may be indicative of a patient having adulterated their urine by diluting it with water. However, it may also be the result of ingestion of very large volumes of fluid. Recommendations; the patient should be retested and asked not to drink large volumes of fluids prior to the urine test.
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