Saturday, September 05, 2009

24 Hour Urine Collection: How to do it and Why it's done















See my highlighted links at the bottom for links to instructions for this test in Spanish and other foreign languages.


What's the Purpose of Urine Testing?


An incredible amount of information can be obtained from examining a urine sample. In fact, over 100 different tests can be performed on a single specimen. Most of the time a simple "quick catch" specimen of urine (voided into a cup) is sufficient for a basic urine test. Urinalysis results may reveal problems with the body's electrolytes or hormones, the presence of infection, dehydration, evidence of microscopic blood (that can't be seen with the naked eye), drug levels, or problems with kidney function.


Why a 24-Hour Urine Collection?


A small sample of urine isn't always sufficient. In addition to blood tests, physicians will order a 24-hour urine collection if they have reason to be concerned about overall kidney function. This test typically focuses on creatinine clearance, sodium, protein, and urine osmolality. Other substances may be examined in a 24-hour collection; for example, hormone levels, urea nitrogen, or copper. The volume of urine that is voided during the 24-hour period also yields important information.  The laboratory will make calculations based on your 24-hour (or 12-hour) urine collection that will help determine how well your body is clearing waste products via the urine.  This finding will be compared to a blood test that measures how much of the waste products are circulating in your blood.

If your physician hasn't explained WHY he or she is requesting the 24-hour urine collection, ask for details. As a patient, being informed is one of your fundamental rights.

Tips for Collecting Your 24-Hour Urine Specimen


A 24-hour urine collection is easy to mess up, and that can be very frustrating. Just one moment of accidentally forgetting to collect and save the urine during the 24-hours ruins the test, and the collection might have to start all over again . . .

Before the test: Your doctor's office will provide you with one or two brown plastic collection jugs and written instructions. Certain tests may require that urine be placed in a "double container" or that a preservative be added to the collected urine; you'll be given the supplies and containers appropriate for your test.


What you need from your lab or doctor's office:
  • Special instructions for the test and a lab sticker with your patient information to attach to the collection container(s).
  • Collection container(s)--depending on the size of container the lab stocks--you may receive one or two of these jugs. They are made of heavy brown plastic, not just any container will do for this collection, so be sure to use the container(s) provided.
  • Nice to have items--I'd ask for these if they don't offer them to you. For men: A plastic urinal to void into. For women: a plastic "nun's hat" to set in the toilet to collect the voided urine. If you don't have these items, it's okay to void into a bedpan, large plastic cup or bowl, etc. You will pour the collected urine into the brown collection container after each void, so it's nice to have something that pours easily.
  • You'll also need: a way to keep the collected urine cool during the collection period. One of the most common ways to do this is to set the brown urine collection jug in larger container filled with icy water (an ice bath). An ice chest (cooler) is another option. It's also possible to place the collection jug in the refrigerator, although there are many reasons to make this impractical.
When to begin? Find out in advance when and where to return your 24-hour urine collection. This information will help you decide when to begin, because if the lab or physician's office isn't going to be open when you finish the collection, you'll have to keep the sample in a refrigerator, cooler, or in an ice bath until you can turn in your specimen. It's often suggested that you begin a 24-hour collection first thing in the morning--but that is certainly not required. However, it is essential that you make note of the date and time that the specimen collection was started and stopped. This information will need to be recorded on the specimen container (and/or label).


Ready to start? Completely empty your bladder by voiding into the toilet and flushing--DO NOT save this first urine sample. The first time you empty your bladder you are flushing away urine that has been building up in your bladder for several hours or more.  That hours-old urine will yield incorrect results if we collect it for our 24-hour specimen.  We want to start with an empty bladder to collect only the urine our body makes during the 24-hour-period. 


Record the start time and determine your stop time. All other urine during the 24-hours will need to be saved and poured into the collection jug. It's helpful to use the same bathroom all day long and post a note with the start/stop time to help remind you to collect all of your samples. Replenish the ice in the basin surrounding your collection jug from time-to-time in order to keep the specimen cool.


Ending the collection: When the 24-hour-collection period is ending, make a last effort to urinate--even if you don't have the urge to "go," you will still be able to produce an ounce or two of urine. Make sure your collecton jugs are tightly capped and labelled with your name, date of birth, collection date and start/stop times.   (Note: If you weren't given a label for your specimen jug, make one and tape it securely to your jug.) Keep the specimen in the ice bath, cooler, or refrigerator until you are ready to return it to the lab or doctor's office. Place your specimen jug(s) in a sturdy plastic bag for easy carrying. (Your specimen will be just fine without being on ice while you return it to the lab or doctor's office---as long as you are not exposing it to heat for a prolonged period of time.)

















    What If . . . ? Special circumstances . . .
    • You filled up the container the lab provided, but your 24-hour-collection is not yet complete. Use a very clean glass or plastic container to continue collecting your urine.  Your brown jug protects the collected urine from light--so if you have to use a transparent collection bottle, be sure to guard it from the light along with keeping it chilled. Using an ice chest would be a good strategy for you in this case--if that's not possible, cover the transparent container with a brown paper bag to protect it from the light.  When you return your sample to the lab, keep the transparent container in a brown paper bag, or some similar technique to keep it protected from the light.
    • You have started the 24-hour-collection, but find you need to leave the house for several hours.  Take a backpack with you, a plastic bottle with a secure lid, and a large ziplock bag full of ice.  This will allow you to carry your collection items discreetly.  For ladies, a wide mouthed plastic container will allow you to urinate and pour the sample into your capped bottle.  Your ziplock bag of ice will help keep your sample cool while you are on the go. I know this is a rather bulky idea, but the best I can come up with at the moment.
    • For patients with urinary catheters. It would be preferable to start your collection with a fresh catheter bag in place--if that's not possible, it would be nice to clean the existing bag--at least remove the bag from the catheter and give it a good rinse out.. Begin your collection by completely emptying the current catheter bag and flushing the accumulated urine. Record this as your start time. During the remainder of the 24-hour-collection period, empty the foley bag into the brown collection jugs at regular intervals and keep the collection jugs in the refrigerator on in an ice bath just as anyone else would do. At the designated stop time, empty your collection bag for the last time.
    • Urine becomes mixed with feces or blood. Do not empty any urine that has been contaminated by feces or menstrual blood into your collection jug. Make note of the time and stop the collection. Contact your lab or physician's office to inform them. In some cases, if enough time has elapsed (12 hours or more), your physician may give the go-ahead to stop the test early. Possibly, you may be asked to start all over again.
    • Patients who are incontinent (cannot hold their urine).  Certainly your physician may not realize (or remember) that a particular patient struggles with complete or partial incontinence.  Do let your doctor know about incontinence issues.  Perhaps the 24-hour-test will be impossible because of complete incontinence; perhaps they might recommend a bladder catheter for the test, or perhaps they might allow a shorter period of time (12-hours or thereabouts) for the urine collection. 
    • "Oops! I didn't collect every void during the 24 hours!" If you forget to collect all of your urine, the test results may be inaccurate. Talk to your lab or doctor's office before disposing of all that you've collected. If you have already completed at least 12 hours of the urine collection, mark down the time of the last urination and keep your container on ice or in the refrigerator as discussed later in this article.  Talk to your physician's office or lab to let them know what you have been able to collect.  They should be able to use your sample and calculate the important information based on the number of hours you have collected--but it's important that they know the correct number of hours when you turn in the sample.  It's possible that you'll be asked to start all over again, but there's a good chance that they can use what you've collected and make adjustments to correctly calculate the results.
    • Why keep the urine specimen on ice?  The ice bath is just a technique for keeping the urine cool enough so that bacterial growth doesn't overwhelm your specimen.  The ice bath should keep your specimen in the 40-45 degree Farenheit range as would your refrigerator.  Keeping a 24-hour-specimen in the refrigerator is really awkward and inconvenient.  Having your specimen container right there in the bathroom "on ice" is so much easier.
    • Other questions? Call your physician's office or lab. If you'd like to suggest anything to make this entry more helpful or accurate--please let me know. I'll gladly tweak this entry to make the information more user-friendly.
    For further reading, check out these links:

    • Please do try your level best to complete the 24-hour-collection for best results.  If you run into a problem with your collection after 12 hours or more, ask your doctor or lab if they can calculate your results using what you have collected.
    . . . http://docs.google.com/gview?a=v&q=cache:Yi0raZ73PAEJ:www.ssmhc.com/internet/home/stclare.nsf/0/F8DF7DDC6ED0F94E862574BE004EF645/%24FILE/24-hr%2520urine%2520collection.pdf%3Fopenelement+how+to+do+24+hour+urine&hl=en&gl=us

    110 comments:

    Anonymous said...

    what if you fill the jug they give you. do you just record that as the stop time? i was only given one jug! the test won't be quite 24 hours exactly, but close...

    Carolyn Cooper, MPH, RN said...

    Great question . . . I'll give you two options on this.

    Yes, go ahead and record your actual stop time and turn in your specimen.

    If it's convenient, as an alternative, I'd suggest collecting the remaining (hours?) worth of urine and putting it into a (very) clean container. Keep the container cool and protected from the light (cover it with something dark). Then you can take that in with your brown jug and get the lab to transfer it into the proper container. I beleive that would be acceptable, but some labs may be reluctant about this.

    Honestly, I think that often the folks who are handing out the equipment to prepare people for the urine collection just don't take this into consideration. These jugs come in a couple of different sizes, but even the large one is often not enough for most people.

    It's difficult enough to find the time to devote to this 24-hour-collection without lacking the essential equipment like the brown jugs and the "nun's hat."

    Frustrating, isn't it?

    Anonymous said...

    They gave me all the stuff in a big bag that I didn't really look into until the night before I was to do the test (I was going to do it on a Sunday, of course, so I couldn't call!) and I realized they only gave me one container. I did it once before and they had given me two, and I had used part of the second one. So I was worried and started googling to find out what to do! Which is how I found your blog. I had decided to do what you suggested (salsa jar!) if needed, but hadn't thought about covering it to protect from light, so thanks for that. I'm doing the test today and I do think I am drinking slightly less water than usual because I don't really want to resort to the salsa jar-- I hope that doesn't do something bad to my results.
    Good blog, btw. Thanks!

    Anonymous said...

    Thanks for the only clearly written clarifications that I was able to find at 4.30am. I'm so grateful!

    Anonymous said...

    I was given a bottle by the hospital to conduct a 24 hour urine collection. Being female I took one look at the bottle opening and thought how on earth do I fill/use this? My friend suggested using a funnel(I thought great idea!), however after searching the shops to no avail, I found an ideal and perfect cheap solution - A cheap plastic microwave pan(89p for 2). It had a handle to hold, was a perfect size and had a pouring spout. I would really recommend this!

    It has taken the trauma out of urine collection!

    Anonymous said...

    how long does it take to get the results back for a 24 hour urine collection...my gp did not tell me and i would appreiciate it iff you could tell me please...many thanks...

    Anonymous said...

    can you please tell me how long it takes to get the results back from gp. for 24hour collection of urine...many thanks..

    Carolyn Cooper, MPH, RN said...

    The results don't take long--you should know something within a few days and certainly in less than a week. Most of the components in a simple urine test are easily processed and reported within a matter of hours.
    If your physician is looking for something unusual, it may take a few days. There are some cases in which lab tests are sent out to a different, more sophistocated lab for further analysis; in that scenario, the results could exceed a week.
    I anticipate that you will receive your results quite soon.

    Anonymous said...

    I finished the 24 hour urine test in 24 hours and 45 minutes by oversleeping this morning! Does that ruin my test results?

    Anonymous said...

    Hi there!
    I have to do a 3 day carb load ending about 48 hours prior to when I planned on starting the 24 hours of collection. I was wondering if the excessive carbs would affect the protein levels in the test.

    Thanks!

    Carolyn Cooper, MPH, RN said...

    Regarding the question about the effects of a 3-day-carb load to be completed 48 hours before your 24-hour-urine collection . . . I'm presuming that the carb load is to take place prior to an exercise event? The carb-load shouldn't effect your urine protein level.

    What could raise the protein in your sample is the presence of Myoglobin IF you are doing very a strenuous exercise regimen that results in injury or muscle damage in the period before the urine collection.

    If I were you, I would probably just provide the information about the carb-load and the reason for it to the doctor who ordered the test so that if there are any abnormals in the results they can possibly explain the findings.
    Otherwise, perhaps delay the 24-hour-urine collection by a week or so if it's not something your physcian is relying on sooner than that . . .

    Anonymous said...

    Actually just carb loading in prep for a 3 hour glucose test, do there will be no extra exercising or activity involved (above and beyond eating chocolate bars and bread anyway)

    Should it be ok the ?

    Carolyn Cooper, MPH, RN said...

    Carb-loading for a glucose test. Well, if your body is having any issues with the glucose control it is possible that there will be a higher than usual level of glucose in your 24-hour-sample. I might go ahead and do the test, and again, explain to your physician when he/she discusses the results with you . . . again, it does depend what the doctor is looking for in your urine test . . . you cold also give them the doctor's office a call and ask them.

    Carolyn Cooper, MPH, RN said...

    Late reply to the person who overslept and finished their test in 24 hours and 45 minutes--no problem with that . . .

    daisymay said...

    I didn't know i wad supposed to flush the first void. Will this alter my results?

    Carolyn Cooper, MPH, RN said...

    If you didn't flush the first urine you collected, basically that changes your start time--if you can recall when you urinated prior to that first sample you collected--probably a couple hours before?--then you would use that as your "start time"--and then go ahead and stop your collection based on that time . . .

    Anonymous said...

    Can I store the finished test in the refrigerator for 24 hours before I bring it to the lab or does it have to be brought in sooner?

    Carolyn Cooper, MPH, RN said...

    Yes, Until you are able to take your collected sample in, it is fine to keep your collection in the refrigerator (or in the ice bath--keep replenishing the ice).

    Anonymous said...

    What happens if I ate avocado the day before the test? I waited until Sunday to open up the bag and then read the instructions and saw that avocado should not be consumed before the test. I ate about a 1/2 of an avocado on Saturday.

    Carolyn Cooper, MPH, RN said...

    This answer is specific only to the previous post question--most of you are not doing a urine collection that has a list of foods to avoid--it depends on what your doctor is looking for.

    So, in response to the previous post, from the dietary restrictions you mention, it sounds like your 24-hour-urine collection is to detect 5-HIAA, which is one of the tests done to try to determine whether a patient has a carcinoid tumors associated with carcinoid syndrome. Serotonin released by such a tumor also occurs in certain foods--like your avocado. When you eat foods that are high in serotonin it can result in a false positive result for your 24-hour-urine test. You need to dump whatever urine you have collected, rinse out the container, and carefully adhere to the written instructions you were given. You can resume your urine collection 24 hours after having eaten food that is on that list. Sorry & I hope you will receive good news after completing this test.

    It's important to know WHY your healthcare provider wants to do the 24-hour-test, and to read any special instructions that you are given, because as the previous poster mentions--sometimes there are dietary restrictions that you must follow. (Also, sometimes there are specific preservatives that must be put into the urine containter.) Here is a link to some instructions for diet restrictions for certain tests: www.ssmhc.com/internet/home/stclare.nsf/0/F8DF7DDC6ED0F94E862574BE004EF645/$FILE/24-hr%20urine%20collection.pdf?openelement.

    Anonymous said...

    Thanks. Rereading the test instructions they only marked cortisone and creatinine for the tests. Hopefully the avocado won't matter since I am not doing the seratonin test.

    Anonymous said...

    I collected my urine and about 1 hour later, my period started. Would it affect the results?

    Carolyn Cooper, MPH, RN said...

    Response to comment above, you sample should be fine--sounds like your collection was already complete so that it wasn't contaminated with blood.

    Anonymous said...

    I planned to start my urine collection on tomorrow morning. However, I started menstrating today. Do you recommend postponing collection until after my menstration has finished?

    Carolyn Cooper, MPH, RN said...

    Yes, you need to wait until it's over. I don't want to be gross, but not to wait risks contaminating the collected specimen with blood and mucus. You don't want to go through the trouble of doing a collection only to have your results possibly tainted by secretions. So, yes, I would wait. And don't forget, when you do start the collection--it can be started at any time of the day as long as you record the time, so you will know when to stop it the next day.

    Anonymous said...

    I have to do a 48 hr urine collection. Do I collect the first urine on day 2 ? If so, does it go in day 1 or day 2 collection jug?

    Carolyn Cooper, MPH, RN said...

    Sorry for the late response. If you are doing a 48-hour-urine collection, you do not have to separate day 1 from day 2. Make sure your lab gives you at least 3 of the gallon collection jugs to ensure you have enough room for the urine you are collecting. And be sure to keep your filled collection jugs cool. A big ice chest would come in handy for such a prolonged collection.

    Anonymous said...

    I did a 24 hr urine collection and I went to the bathroom in the middle of the night and left my urine in the collection bin for about 6rs before filling the jug which was in the refrigerator. First thing in the morning I put the urine in the jug which was refrigerated. Do you think this will cause bacteria to grow and ruin the test?

    Carolyn Cooper, MPH, RN said...

    Regarding the last comment/question about urine not placed promptly into the collection container and kept cool . . . The way you proceeded in this instance will probably be okay. If there is any question about results, you can always share that information with your physician.

    TigerLily320 said...

    I completed a 24 hour urine collection on Saturday and turned it in the same day. I am being tested for a pheochromocytoma. How long until I get the test results back? will it take longer because of the weekend?

    Carolyn Cooper, MPH, RN said...

    Regarding the 24-hour-urine for pheochromocytoma: The fact that you turned in your sample on the weekend could possibly suggest day or so longer for your result, but without knowing the capability of the lab, it's only speculation. There are actually some 24-hour-urine tests that can take up to 2 weeks for results to be posted. I can't honestly say what will be the case with your results. You might want to post this question to your doctor's office (or the lab). I would be interested to learn the answer.

    Also, the 24-hour urine for pheochromocytoma is one in which it is extremely important to collect ALL of the urine, since the chatecholomines this test is looking for are secreted at unforseen intervals over the 24-hours. That's why the total volume of urine is required to analyze the ratios.

    Anonymous said...

    My niece needs to do 24 urine to detect 5-HIAA. she was given a list of foods to avoid ,however she had bariatic sleeve surgery 2 wks ago and has very limited amounts and pureed foods she can eat. She also needs to take in at least 65 gm of protien/day which she manages with protein shakes. Can she use strawberry shakes? The other flavors are chocolate and vanilla (on list of restrictions) She spoke to her nutritionist and staff in surgeons office who ordered the test but they did not know the answer please help

    Carolyn Cooper, MPH, RN said...

    Regarding the comment/question above about the dietary restrictions for the 5-HIAA test. The shor answer is, yes, the strawberry shakes are fine.

    Here is a fairly long answer to explain why . . . In the test for 5-HIAA (5-hydroxyindoleacetic acid), certain foods that contain serotonin (which is a precursor of 5-HIAA) could cause the results of the test to be falsely positive. That is why individuals undergoing those specialized 24-hour-urine tests are given a list of foods to avoid.

    I looked a number of reliable sources and do not find strawberries among any of the foods to exclude. Some exclusion lists suggest avoiding “fruit” in general, but in the best scholarly research article I found, (see reference and link below), citrus fruits are the ones implicated. The Strawberry is not a citrus fruit, and I would be completely comfortable in making that choice for your niece’s protein shake.
    The most commonly cited foods to avoid (2 to 3 days ahead of time and during the 24-hour-collection): Plantains, Kiwi fruit, plums, pineapples, bananas, tomatoes, eggplant, avocados, grapefruit, cantaloupe & honeydew melons, black olives, spinach, broccoli, cauliflower, figs and walnuts.

    This is a very good scholarly research article in which the serotonin content of 80 foods was examined: Serotonin content of foods: effect on urinary
    excretion of 5-hydroxyindoleacetic acid, by Jerome M Feldman, MD and Ellen M Lee, published in The American Journal of Clinical Nutrition 42: OCTOBER 1985, pp 639-643. You can link to this article directly for further reading: http://www.ajcn.org/content/42/4/639.full.pdf

    Your neice will be given a specimen container that contains a preservative--very important for this particular 24-hour-urine test.

    Other worthwhile and reliable links about the dietary and medication restrictions important to prepare for the 5-HIAA test include:
    http://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/9248
    http://www.carcinoid.org/content/preparing-24-hour-urine-5hiaa-test
    http://www.ddeamc.amedd.army.mil/clinical/pathology/DPALS5HIAA.aspx
    http://health.nytimes.com/health/guides/test/5-hiaa/overview.html

    TigerLily320 said...

    I have finally received my results of my pheochromocytoma. It has come back negative but my Dr is still convinced I have the tumor. Thank you for your help

    Anonymous said...

    Weird question, but what do I do with the "hat" after the test? Do I take it along with me to the lab, or is throwing it away okay? I would assume that they wouldn't want it back, but you know what they say when one assumes...

    Carolyn Cooper, MPH, RN said...

    The lab won't want the "hat" back. You can rinse it out, then wash with hot soapy water and keep it "just in case" you or someone else needs it in the future. (If you have little kids or frail elderly folks in your life, something like this can be very helpful if they need to collect a stool or urine specimen in the future. You can certainly throw it away, that's what they would do if you returned it to the lab.

    Anonymous said...

    I have been using a plastic cup to collect the urine. Can I rinse and reuse the same cup or should I use a new one each time? Also, where can I buy a 'hat'? Thank you!!

    Carolyn Cooper, MPH, RN said...

    Regarding question above--yes, reusing/rinsing the cup you are using to collect is fine. AS for where to get the "Nun's hat"--the lab/hospital/clinic should have given you one--they are standard items in the healthcare setting. You can get them on ebay--I actually ordered some from ebay to redo the photos on this blog--which I haven't done yet. The cost was not high and they shipped quickly. You also rinse and repeat to clean the "hat." Oh, and I once saw one of those "hats" for sale at a yard sale--I didn't buy it, though. ;)

    Anonymous said...

    Hi,
    I started my 24 hour urine collection on Tuesday at 5:30 am. I collected my urine all day and night until 11:00 pm. I got up at 12:30 am to go to the bathroom and dropped, yes dropped, the cup of urine on the floor. Does this mean I need to start all over? Or should I stop the collection now and record the 11:00 pm time? Or should I continue collecting until 5:30 am and tell the lab about dropping a cup? Thank you for this wonderful and very helpful blog.

    Carolyn Cooper, MPH, RN said...

    Yikes!! It's such a bummer to have a glitch in the 24-hour-urine collection. To the person who commented above, so sorry to hear about that dropped cup of your speciment.

    What to do in this situation. The "right" answer is always to dump and start all over . . . truly that's the best way to be certain of accurate results. And if your urine test is for something like pheochromocytoma--you really need to get every bit of the urine, because in that case, for example, the chemicals under scrutiny are randomly secreted by the body, so missing a sample collection would mean the real possibility of a lost opportunity to rule in/rule out the suspected diagnosis. Hope that makes sense . . .

    Anonymous said...

    Is the start time when the 1st urine is flushed or when the 2nd is collected? Thank you.

    Carolyn Cooper, MPH, RN said...

    For Anonymous (above). The start time is when the 1st urine is flushed--and the end time is 24 hours later.

    The reason for this is so the test starts when your bladder is empty, i.e. you just voided whatever urine had been in there for hours. Now you now all the urine produced after that time was part of the current 24 hour period.

    Have trouble "seeing" that in your mind's eye? Think of the urinary bladder as a laundry bag. If you want to find out how much and what kind of laundry goes into the bag in 24 hours time, you are going to start with an empty laundry bag, right? So if your laundry bag has a few socks or towels left in there from YESTERDAY--you will dump them out into the washing machine before you start to collect your 24-hour-"laundry."

    Sometimes an example like the laundry bag scenario is useful, hope it doesn't confuse anyone!!

    Thanks for reading . . .

    Anonymous said...

    I am going to start a 24 hour urine collection for hormone testing either tomorrow or the next day as per my DRs instruction. My question is...will having intercourse without protection interfere with the results. I am assuming it will but forgot about the test coming up and had sex this morning. Anyway, how long should I wait afterwards before beginning the urine collection? Thanks!!!

    Carolyn Cooper, MPH, RN said...

    Regarding comment by Anonymous above, you should be able to begin your collection tomorrow without an issue, as of course you will place excellent attention to your hygiene today . . .

    Anonymous said...

    I am doing a 24 hour urine test to see if I can donate a kidney. How many hours after the test can I wait to turn it in and do the associated blood work? Is 72 hours too long?

    Carolyn Cooper, MPH, RN said...

    Regarding the comment above, as long as you keep the collection cold, you will be fine returing it in 72 hours. I would suggest placing the collection bottles in an ice chest and pack in the ice until you can turn it in to the lab.

    Anonymous said...

    I am doing the 24 hour urine test for hormone testing.
    Does it matter if I have insomnia and am peeing a few times during the night BEFORE starting the test?
    Just want to make sure I don't start off on the wrong foot and mess up the results. Thanks!

    Carolyn Cooper, MPH, RN said...

    Regarding comment above--don't worry about any "output" that occurs before you begin. You are starting with an empty bladder and will collect 24-hours worth--that is your focus--only what you produce within the 24-hours.

    Anonymous said...

    You are a real dearheart. Thanks SO much for taking the time to answer my question so quickly. It gives me some peace of mind about proceeding with my test.

    I was interested to read your answers to other posters as well. Most internet searches on the subject turn up standardized instructions that don't take into account personal concerns and worries.

    This is so helpful!

    Anonymous said...

    I was given a drug test and i was never ask if i was taking any medication,,and when i gave the collector my cup she let it sit for 4 to 6 min.with no top on it before testing the temp.she gave me 3 hours to do another sample and i couldn't do it so they decide it was positive,,was I violated

    Carolyn Cooper, MPH, RN said...

    To the commenter above, I received your email and have responded.

    Anonymous said...

    Do I have to restart the collection if I missed a few "dribbles" that snuck out after Or during a bowel movement ?

    Carolyn Cooper, MPH, RN said...

    It is is truly dribbles, I would not restart . . .

    Anonymous said...

    Hi I have to do a 24 hour urine collection. The doctor want to test my Creatinine and Metanephrines. I just wanted to make sure what I can and cannot eat when on the diet for it. Thanks

    Carolyn Cooper, MPH, RN said...

    The test for metabephrines is sensitive to food, drugs, and even stress. It is very important to follow the directions that your lab or doctor SHOULD have given you about this collection. Here is a link to an article about this test: http://labtestsonline.org/understanding/analytes/urine-metanephrine/tab/test

    For a really good pdf format information sheet on specific urine collections and foods to avoid, I recommend using Google search terms "St Clare foods to avoid for urine tests."

    If your lab or doctor did not give you an instruction sheet--please let them know about this oversight before you start your collection to ensure important information is not overlooked.

    Carolyn Cooper, MPH, RN said...

    Regarding the metaphrine test used to help determine whether a person has pheochromcytoma--please also see this good health link: http://www.fairview.org/healthlibrary/Article/LTO_URINE_METANEPHRINE.

    Pay particular attention to this parapraph from the article: "It is very important to talk to your doctor before discontinuing any prescribed medications. He will work with you to identify interfering substances and drug treatments to determine which of them can be safely interrupted and which must be continued for your well-being. Some of the substances that can interfere with metanephrine testing include: acetaminophen, aminophylline, amphetamines, appetite suppressants, coffee, tea, and other forms of caffeine, chloral hydrate, clonidine, dexamethasone, diuretics, epinephrine, ethanol (alcohol), insulin, imipramine, lithium, methyldopa (Aldomet), MAO (monoamine oxidase) inhibitors, nicotine, nitroglycerine, nose drops, propafenone (Rythmol), reserpine, salicylates, theophylline, tetracycline, tricyclic antidepressants, and vasodilators. The effects of these drugs on metanephrine testing will be different from patient to patient and are often not predictable."

    Also, this is one of the 24-hour-urine tests that relies on careful and extremely faithful attention to the collection process. The substance being evaluated is secreted through the kidney's randomly throughout the day--if any sample during the 24-hours is wasted in some way, the results could be very wrong.

    Anonymous said...

    Hi,
    I am wondering if you are familiar with 24 hour urine collections to test for PCOS. I am doing this along with many blood tests to confirm my diagnosis. I was only given the jug and told to do a 24 hour collection. The only instructions my physician gave me was to not use the first void of the day. I am not aware of what actual tests are being done on my specimen and just wanted to make sure there were not any extraordinary precautions I need to take in my case.
    Thank you

    Carolyn Cooper, MPH, RN said...

    I would urge you to call your doctor's office and ask to speak with his nurse to get the specific information about what test was ordered. As an alternative, you could call the lab where the test was ordered to make this inquiry.

    That being said, when physicians are trying to make a diagnosis of Polycystic Ovarian Syndrome, they look for other possible causes of the symptoms . . . one of the tests that is often performed is a 24-hour urine test for "free cortisol." This test looks at the amount of cortisol (a naturally occurring hormone) that is secreted in 24-hours. This is a test where it is important to be reliable about collecting all of the urine. Cortisol is secreted in varying amounts throughout the 24-hour period, so not being faithful with the collection process increases the chance of an inaccurate result.

    Anonymous said...

    I am preparing to take the 5-hiaa 24 hour urine test the lab says no coffee, can I drink decaf ?? they are testing for carcinoid syndrome,

    Carolyn Cooper, MPH, RN said...



    Regarding the question about drinking decaf when preparing for the 5-hiaa test: There is caffeine in decaffinated coffee--up to 3%--a small amount, sure, but it is very important to avoid ALL caffeine-enriched products (including tea, soda, etc.) to ensure an accurate result of this very sensitive study.

    So, "no decaf" for the 5-hiaa test. Also, check out this link to read more about preparation for this test: http://www.carcinoid.org/content/preparing-24-hour-urine-5hiaa-test

    Anonymous said...

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    Unknown said...

    Your blog is very useful! I have to collect my urine too, the doctor wants to know whether there is any microalbumin in it or not. Unfortunately in the night I had to go to the toilet and the amount of the urine was so much then that it didn't fit in the plastic cup so a little went to the toilet. Do you think it will ruin the result of my test? Thank you!

    Carolyn Cooper, MPH, RN said...

    Response to the above question/comment. If it really was a very small amount of the sample that was lost in the commode, you are not going to have a ruined test. The microalbumin test looks for the average amount of albumin that spills through the kidney's filter into the urine. This process occurs on a constant basis, not like some of the tests where they are looking for something that can occur at random, unexpected times.

    Anonymous said...

    Three years ago I took a 24 hour urinary free cortisol test and when I got home I started my menstural cycle when I called the lab they said it didn't matter. Now I am supposed to take another soon and I was wondering if medications or foods effect the test. I've had a tumor on my adrenal gland for over three years with nothing done since the contaminated urine test. Please help me because I have many of the symptoms of cushings syndrom and I don't want to mess this test up.

    Carolyn Cooper, MPH, RN said...

    In answer to the question above, there are some very reliable references for the free cortisol tests online, and I'd like to invite your attention to the information at the following link for starters: http://csrf.net/page/diagnostic_testing_for_cushings_syndrome.php

    To specifically answer your question about preparation for the free cortisol test: Don't drink alcohol during the test--and it's best to avoid alcohol at least several days before. Healthy kidney function ensures correct results, so your healthcare provider will have tested to ensure your kidneys are adequate before doing the 24-hour-test. Also avoid skin creams or hemorrhoid products that contain steriods during the 24-hours that you are collecting your urine.

    Finally, check out this "Patient's Guide to the Diagnosis of Cushings Syndrome": http://www.google.com/url?sa=t&rct=j&q=&esrc=s&frm=1&source=web&cd=15&cad=rja&ved=0CDUQFjAEOAo&url=http%3A%2F%2Fwww.hormone.org%2FResources%2FPatient_Guides%2Fupload%2Fmgmt-cushings-syndrome-070609.pdf&ei=QDyHUJOPH-TWyQHNpoDgCQ&usg=AFQjCNEnQghBNi8J94uA5Ek6w4e-JH9Jqg

    Remember with the free cortisol test, it is important to be reliable about collecting all of the urine. Cortisol is secreted in varying amounts throughout the 24-hour period, so not being faithful with the collection process increases the chance of an inaccurate result.

    Anonymous said...

    I'm currently doing the 5H1AA 24 hour urine collection.

    This is my third attempt at this. The first time they didn't tell me that I couldn't eat certain foods. Then I started the next one the following day before I read the fine print that I couldn't eat those foods for 4 days prior.

    So, for this one, I started this morning at 5:40am (disposed of it in the toilet). Then at about 9:30am, I poured my first sample into the jug. Then at about 10:30am, I showered and while in the shower I accidentally peed a little bit, maybe one ounce - two at the most.

    Because this jug had the sulfamic acid, I can't dump it and start over.

    I'm wondering if this will affect the results if I just continue to complete the 24 hour collection.

    If the results show that I have high levels of serotonin, then does that mean that the results are accurate, even though I didn't capture every drop?

    If the results show normal levels, did I possibly mess up the accuracy of the results by not capturing every drop?

    Also wondering... last night I had the sudden flushing of my face happen, and if it was caused by serotonin being secreted, would my levels in my urine be higher today, this many hours later?

    I'm hoping I don't have to try for a fourth time. Please let me know your thoughts.

    Carolyn Cooper, MPH, RN said...

    Regarding the comment above, I would just go ahead and finish the test with the most diligent attention in completing it.

    As to the question about what the results might show based on your symptoms a day prior, I'm sorry, I just can't speculate on that.

    Best wishes for a good outcome.

    Anonymous said...

    I am due to do the 24 hr urine collection this Sunday. I have a family party on Saturday. Should I abstain from taking any alcohol on Saturday or would a few alcoholic drinks be ok and not mess up the urine collection and testing?

    Carolyn Cooper, MPH, RN said...

    Regarding your question about drinking alcohol prior to your 24-hour-urine collection. Not knowing what exact 24-hour urine test you are facing, I would recommend reviewing whatever instructions you were given by your doctor and/or lab. With some of the 24-hour urine tests, the consumption of alcohol may, in fact, affect your results. If you are unable to discern the information from the instructions provided by your doctor, I would defer the test to another day . . . Best wishes . . .

    Anonymous said...

    I am almost finished with my collection. I will finish at 7:00 AM in the morning. I could not take my diuretics while collecting so I have very little urine thus far in my container. Then, in my haste to go to my parents for our Thanksgiving meal, I left the collection jug out of the refrigerator for about 3 hours. It's cool in our house and no heat was on. Do you think the sample will be OK since it was unrefrigerated for 3 hours? Also, is there a minimum amount of urine needed for the test?

    Carolyn Cooper, MPH, RN said...

    Regarding the comment above--I think your sample should be okay to turn in despite the minor setback. As far as the volume you have collected--don't worry if it seems "too little"--part of the whole test is to figure out exactly what your kidneys are doing in a typical/random 24-hour-period of time. Trying to artificially encourage more urine production by drinking more, for example, doesn't really give the true picture of what your kidneys are doing on a usual day. So, again, I think your sample will be sufficient as it is. Best wishes.

    Anonymous said...

    Thanks so much for your quick response...so glad I found your site!!

    Elizabeth Taft said...

    Thank you for sharing your knowledge- I am pregnant and recently completed one of these tests. After reading the information you have provided, I feel like I have a better understanding of the test and will be more confident in asking questions when I see my provider to get the results next week.

    Sammy Finch said...

    Thank you for sharing this information on urine collection. I didnt know that this was a thing but I can see why it would be beneficial!

    Anonymous said...

    First of all, thanks so much for being so generous with your time and answering everyone's questions.

    I am doing a 5HIAA test. The doctor gave me three jugs to fill over a 72 hour period. I did one last week and turned it in and then started a 48 hour collection yesterday (sunday) morning at 0610 (voiding into toilet). This morning at 0610 I woke up, collected a sample, and the 1st jug could not take my entire morning sample so I just poured the rest into the 2nd jug I was going to use for this following 24 hours. Is this approach okay or are the ratios measured per jug very dependent on each specific jug having all the urine in a 24 hour period?

    Ultimately I thought it was okay as long as I captured everything that came out yesterday and today for analysis in the two jugs, will just drink less today.

    Carolyn Cooper, MPH, RN said...

    To the comment above, you should be just fine. Each jug doesn't have to be "only" for that 24 hours sample if you are doing a 48-hour collection, and they really should have given you another jug as well. Anyone doing a urine collection is not meant to have to drink more or less than their usual volume of fluids. Best of luck!

    Anonymous said...

    I was given 2 different 24 hour urine tests. If I do them back to back do I use the same start/stop times? Does the morning urine from the first test count as the first voided for,the next fay? Also, how long do I have to turn it in? They said the same day, but is there a limit on how many hours father completion?

    Carolyn Cooper, MPH, RN said...

    To Anonymous above, Interesting questions, and you have the right idea. If you are going to do the tests back-to-back without taking a break then, YES: do the last void for your first collection. Then use that as the start time for your second collection (because, of course your bladder is empty and that's what is needed for your start time). If you keep the collection on ice or in the frig--you can give it a couple days. You can use a drink cooler with ice for the completed collection until you are able to take it in. Be sure to label your bottles very carefully so that you (or the lab) doesn't get them mixed up). You could even tape a label on each bottle to make it clear which is which.

    Janice S said...

    I will be collecting a 24 hour specimen for protein. One of the chemotherapy drugs that I take elevates Blood Pressure & protein in the urine. I am more concerned about the protein levels than my oncologist.

    Anonymous said...

    Hello, i've started my 24 hour creatinine clearance at 655 this morning, but i seemed to have started spotting around 2045 now. Was about to void again, but noticed..i still haven't gone, as I'm unsure if it will contaminate the collection. Shall I stop for now, and just check with lab tomorrow since it has been over 12 hrs of collecting? If all else fails, can I just use same jug and dump contents and start again once my period is done? do i have to rinse the container? thank you...:)

    Carolyn Cooper, MPH, RN said...

    Hi, to the latest question--I just got your message, so you have probably got this figured out. I would have stopped the collection and contacted your physician's office the next day to determine if a 12 hr collection was okay for your test. If not, I would have dumped it, rinsed the container, and dried it by turning upside down to drain on a towel (with the lid off).

    Anonymous said...

    I am taking 24 hour urine test to look for pheochromocytoma. Lab instructions were no refrigeration, use first urine of the morning. Upon reading this blog I see that that is all incorrect. At 7:30 pm I took 5htp and beta blocker. I urinated at about 3:30 am and discarded. I collected at 7:30 am. Will this sample be accurate? Is my end time 3:30 am. I have a double container. I noticed that only one side had the chemical in it. Is this container good? thanks for your help.

    Carolyn Cooper, MPH, RN said...

    Responding to above question:

    Q: “I am taking 24 hour urine test to look for pheochromocytoma.”
    A. The 24-hour-urine test is the gold standard for diagnosing Pheochromocytoma, so you really want to do this “right.”

    Q. “Lab instructions were no refrigeration . . . “
    A. Did the instructions specifically state something like “do not refrigerate” or “no refrigeration”? If so, I am really surprised, because I am personally unfamiliar with a 24-hour-urine collection in which it is not advised to keep your specimen in an ice bath to cool it, or refrigerated. (I prefer the ice bath—your collection is handy right by the commode and the “ick factor” of having pee in the frig is something to consider . . . not to mention that the collection bottles are awkward for storage in a frig.

    Q.”[Lab instructions were] . . . use first urine of the morning.”
    A. Hopefully my blog post makes it clear that you may start a 24-hour-urine at any time of the day, it is more convenient for some people to “remember” to start and end their collection when they begin it first thing in the morning, but it’s not required. I assure you that in a hospital setting, the 24-hour-urine collection is started as soon as it is ordered and the collection hat, urine bottle, and ice bath is placed in the restroom. Your 24-hour collection will include urine in your bladder from the entire 24-hour-period, so you WILL eventually have some first morning urine in your bottle . . . but you DON’T HAVE to start it first thing in the morning.

    Q: “.At 7:30 pm I took 5htp and beta blocker.”
    A: Were these medications part of the collection instructions? I would just want to be sure of that—don’t stop any medications unless your doctor says it is okay, but be sure what you are taking is not going to interfere. With the 24-hour-urine test for pheochromocytoma, there are typically foods and medications that are supposed to be avoided as they can influence a false result on your collection. Most common instructions for this particular test include avoiding food/beverages with caffeine or vanilla; also instructions usually suggest to avoid Tylenol, aspirin, licorice, bananas, walnuts, avocados, fava beans, cheese, beer, and red wine or other alcoholic beverages. Avoid being chilled, keep stress free, be sure you are well hydrated.

    A. “I urinated at about 3:30 am and discarded. I collected at 7:30 am. Will this sample be accurate?”
    A. So far so good, but I would put the collection bottle with the urine in a cooling ice bath.

    Q: Is my end time 3:30 am.”
    A. Yes—your stop time is 3:30 am. At that time, you urinate one more time and put it in the bottle—that’s it.

    Q. “I have a double container. I noticed that only one side had the chemical in it. Is this container good?”
    A. I think you will be okay with the (chemical preservative) only in one compartment as long as you are keeping your collection cool.

    Anonymous said...

    I am also doing the 24 hour 5HIAA test. I've been doing well, but the dietary restrictions are hard to follow. I was good up until today (day of collection), when I was out in the garden picking tomatoes and I forgot and popped two cherry tomatoes into my mouth. As soon as I swallowed I realized what I had done and cursed out loud. Am I going to have to start over?

    Carolyn Cooper, MPH, RN said...

    You are fortunate to have cherry tomatoes on the vine right now. I would not worry about these two little tomatoes, but would note on the collection ID tag, perhaps that you did have that small dietary lapse.

    Anonymous said...

    I'm amazed how quickly you answered my question! I wish I could send you a bushel of tomatoes, haha:). Thank you. I will note my lapse and take heart that I may not have to start over:)

    Tia said...

    Hi,
    Doing the 24-hr urine collection, started this morning (Monday), was not told to refrigerate/ice it.... It's not a hot day, house was pretty cool. Do you think sample will be accurate, or should I start over?
    Thanks!

    Carolyn Cooper, MPH, RN said...

    Often readers want to know if they need to restart their collection for one reason or another . . . The basic guidelines are in the blog post above. Just apply your good judgment to your specific circumstances. Regarding the question above: If you have collected a large volume of urine and it’s been at room temperature for many hours—I think that is a bad idea—I would restart and do it right (rinse the container). If you just started a couple hours ago and have collected a small amount—perhaps you will be fine to just go ahead and put your collection in the cooling ice bath.

    Anonymous said...

    Thanks for all the great info. I have done many 24hr collections to test my light chains for myeloma. I'm scheduled for transplant at the end of the month. I usually do my collections on Sundays to avoid the "backpack" can I collect on Sunday and refrigerate until my appt on Wednesday morning?

    anonymous said...

    My daughter did s 24hr urine yest to check cortisol level I didn't realize until after there was some water in the hat from when I rinsed it will that cause a problem with results

    Carolyn Cooper, MPH, RN said...

    Regarding comment above. How much water was in the hat? Just a very small amount--like an ounce?

    If it was a very small amount of water--I would not worry about that.

    dee said...

    Why is all the urine collected in one big jug? Why not individual containers with the time marked

    Carolyn Cooper, MPH, RN said...

    Regarding Dee's question above. Wow, you are thinking outside the box. That is a good question. I suppose it would be more labor intensive, and therefore costly, to collect the total specimen from each individual void to examine in the lab . . . I've never known it to be done in places that I have worked, but perhaps there are some doctors who are looking at that level of detail. Thanks for the question.

    Anonymous said...

    I am doing a retest for protein in my urine. This time I was given two containers for the 24 hour sample. I was verbally given instructions and am not certain that I am recalling them correctly. Any urine collected during the day goes into the 1st container. I believe that I am only supposed to put the next morning urine (end of 24 hour) into the 2nd container. Is this correct? If I wake up in the middle of the night that urine goes into the 1st container...correct? My start time was 4:45 am.

    Carolyn Cooper, MPH, RN said...

    Regarding the comment above, by anonymous--please call the location where you received the containers. Often they give two containers just in case the first one gets full--so you have another container available.

    They may well want you to use both containers for some specific reason, but if so, I am not familiar with that protocol. Please let us know when you find out, so we can all learn from your experience. Thanks so much.

    Anonymous said...

    My instructions say that I must be present when urine is dropped off and they will draw labs. However, my husband is having a procedure done that morning & I need to be with him. Is it necessary to have the blood drawn at the same time or can I do it later in the day?

    Carolyn Cooper, MPH, RN said...

    To anonymous (above), your doctor wants that blood test in order to closely correlate the results of your 24-hour urine test. I am not sure which test you are doing for your 24-hour collection--maybe creatinine?

    If it isn't convenient for you to accomplish all of this at the same time, (and I can see your dilemma), you may want to delay the 24-hour-collection a few days until more convenient, OR call your physician's office and ask to speak with his nurse. Ask her if you can delay the blood draw.

    Can you possibly break away while your husband is having his procedure and to to the lab for the blood draw?

    Anonymous said...

    Due to the timing of an IV I had to get, my 24 hour test started at 5:00pm. I'm close to finishing but realize the lab will be closed when I'm done. Can I just continue to store in fridge and take it tomorrow?

    Carolyn Cooper, MPH, RN said...

    Yes, you can absolutely store your specimen in the refrigerator or in an ice bath until you are able to return it to the lab. Good luck with your results!

    Anonymous said...

    Hi, does the hat need to be wash out after every use? If so just rinsed out with water?

    Carolyn Cooper, MPH, RN said...

    If you want to rinse the hat after you empty it, that's fine (and probably nice to do if you are sharing the bathroom with others). Just make sure it's dry when you use it so you don't risk diluting your sample.

    Arnita Mouhcine said...

    I finished my collection today, Saturday, but the lab isn't open until Monday. Will it be okay for testing?

    Carolyn Cooper, MPH, RN said...

    Keep your collection on ice or refrigerated until the lab is able to accept it.

    It's okay to have the collection container at room temp for the short amount of time it takes to actually transport it to the lab, however.

    Anonymous said...

    I emptied day one at 5.30 am, then took a nap and collected my 10.30 urine. Next day i awoke at 7am and collected this. Now i am done, right? Will oversleeping today screw this up? I realize i should have ended closer to 5.30am on day 2.

    Carolyn Cooper, MPH, RN said...

    Don't worry. You should be fine on this.

    Anonymous said...

    I am doing a 24 hour urine test to check for pheochromocytoma (multiple tests) and carcinoid (5HIAA?). I am on my third try - the hospital where I pick up my collection container has given me a container twice now with preservatives/acid in it (four or so while tablets) instead of an empty container...as LabCorp adds their own preservatives/acid. After the first test, the metanephrine/creatine/etc. test all came back normal, but they didn't complete the 5HIAA test because of a messed up pH level - could the fact that preservatives were in there that shouldn't have been (because LabCorp would've added a second dose of preservatives/acid) have caused an issue with the results that did come back (I demanded a second test, which has no become a third, because of this fact...but I can't find anything online that speaks specifically to it)?

    Carolyn Cooper, MPH, RN said...

    To Anonymous on March 8, 2014: Your question is over my head, but I do have a thought about what you are asking . . .

    Seems you are picking up the container from one location (hospital), but another place (Labcorp) is doing the processing of the specimen . . . I think for consistency and simplicity--use the same location. If hospital gives you a collection container that Labcorp doesn't find appropriate--it's too complicated. Stick with one place to do both and I think it would be easier.

    Something is really odd for the pH to be "too messed up to do the 5H1AA." It's out of my area of expertise, but I think any of us know enough to suspect an error somewhere in the process, whether is be the collection container or something else.

    activjac said...

    Will having a glass of wine affect my 24 hr urine collection test that is for protein and creatinine clearance?

    Carolyn Cooper, MPH, RN said...

    One glass should not make a big difference in that test. Everyone should read the instruction sheet for their particular test. Some 24 hour urine tests do have restrictions on alcohol intake for most accurate results.

    activjac said...

    Thank you