This is Can Peng's presentation assignment for Chapter 11. The course is Biology 120 (online) at the City Colleagues of Chicago for the Summer 2018 semester.

1. The presence of sugar or glucose in the
urine - glycosuria
 Causes
 Types
 Symptoms
 Potential complications
 Diagnosis and treatment
 Prevention strategies
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The most common causes of glucose in urine
Web photos retrieved from https://www.medindia.net/patients/patientinfo/glycosuria.htm,
http://intranet.tdmu.edu.ua/data/kafedra/internal/chemistry/classes_stud/en/pharm/prov_pharm/ptn/3/05.%20INVESTIGATION%20OF%20CATA
BOLISM%20AND%20BIOSYNTHESIS%20OF%20GLYCOGEN.htm, https://www.sott.net/article/316427-Its-not-cancer-after-all-Doctors-
reclassify-thyroid-tumor, and http://www.medpractitioners.com/liver-cirrhosis/.
• High sugar diet: Consuming high sugar diet can
raise the blood glucose past the threshold that the
kidneys can properly reabsorb.
• Diabetes mellitus (undamaged): The lack of
insulin in the blood elevates the glucose levels.
The excess blood glucose levels make it difficult
for the kidneys to properly reabsorb the glucose
back into the bloodstream, leading to some
excretion in the urine.
• Hyperthyroidism: Overproduction of thyroid
hormones can cause decreased absorption of
glucose that is then leaked from the filtrate and
passed into the urine.
• Liver cirrhosis: This disease affects carbohydrate
metabolism, resulting in high blood glucose levels
in the blood that exceed the renal threshold and
cause glucose excretion in urine.

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The most common causes of glucose in urine
• Emotion: Fear, anger, and anxiety can cause the release of adrenaline, which promotes the
breaking down of carbohydrates to produce energy for a “flight or fight” reaction.
Consequently, a temporary rise in blood sugar levels occurs, which and potentially an
increase in urine glucose as well. Such an event results in temporary rise in blood sugar
levels, which can exceed the renal threshold and an increase in urine glucose.
• Pregnancy: Increased renal blood flow decreases the renal threshold, thus eliminating more
sugar in the urine.
• Raised intracranial pressure: Sometimes glycosuria can be seen in patients with increased
intracranial pressure and other brain lesions, due to the activation of the sympathetic nervous
system and the consequent alterations in carbohydrate metabolism.
Web photo retrieved from https://us.hellomagazine.com/healthandbeauty/health-and-fitness/2017022036768/how-to-exercise-during-pregnancy/

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Other possible causes of glycosuria
Web photo retrieved from https://www.medindia.net/patients/patientinfo/glycosuria.htm
• Renal tubular disease (with reduced renal
threshold and reduced glucose reabsorption)
• Kidney infections
• Post-gastrectomy
• Interstitial nephritis
• Hereditary tyrosinaemia
• Glucose-galactose malabsorption in the
intestine
• Wilson’s disease
• Cystinosis
• Heavy metal poisoning (lead, mercury, etc.)
• Certain drug usage (cephalosporins,
penicillins, nitrofurantoin, methyldopa,
tetracycline, lithium, carbemazepine,
phenothiazines, steroids, and thiazides)

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Types
• Alimentary glycosuria: A condition due to high sugar diet.
• Benign glycosuria: A rare, inherited condition in which the filtering system
of the kidneys allows sugar to pass into the urine. It usually has no other
symptoms.
 Type A: Most common type of glycosuria where there is a decline in both
renal glucose threshold and maximal glucose reabsorption rate.
 Type B: The rate of reabsorption is normal but there is a decline in the renal
threshold.
 Type O: Glucose reabsorption does not happen in the kidneys, resulting in
lots of glucose excreted through urine. The serum glucose, glucose tolerance,
and insulin level are normal.

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Symptoms
Web photo retrieved from https://www.medindia.net/patients/patientinfo/glycosuria.htm
• High urine glucose level with a lot of
white blood cells and proteins
• Renal pain
• Difficulty in passing urine
• Frequent urination
• High blood sugar levels
• Infections
• Fever
• Abdominal pain
• Excessive hunger
• Fatigue
• Unexplained weight loss
• Slower healing of wounds
• Excessive thirst

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Potential complications
• Cardiovascular (heart attack, stroke, high cholesterol, and hypertension)
• Vision issues
• Nerve irritability and damage
• Tingling sensation in hands and feet
Web photo retrieved from https://www.thedoctorasky.com/arrest-and-stroke/

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Diagnosis
Urine glucose level
Test Result mg/dL mmol/L Note
Trace
Glucose in
urine
100 5.55 The trace amount of glucose in the urine
suggests a high blood sugar.
Glucose 1+ 250 11.1 The patient has lost 250 mg/dL of glucose
via urine.
Glucose 2+ 500 27.75 The patient has lost 500 mg/dL of glucose
via urine.
Glucose 3+ 1000 55.5 The patient has lost more than 1000 mg/dL
of glucose via urine.
Glucose 4+ 2000 111 The patient has lost over 2000 mg/dL of
glucose via urine.
The glucose level in a urine sample can be measured through a
dipstick test which employs the glucose-oxidase/peroxidase
reaction to specifically screen for glucose.

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Web photo retrieved from https://lifeinthefastlane.com/investigations/urinalysis/
Urinalysis - a dipstick test
• Glycosuria may not always indicate high blood glucose levels.
• Renal glycosuria may show negative in blood glucose tests but positive in glucose
urine.

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Treatment
Glycosuria is not necessarily a serious or life-threatening condition.
• Find the cause of glycosuria to determine if the condition is chronic or
acute.
• Manage diabetes, hyperthyroidism, and kidney function to help reduce
excretion of glucose in urine.
• Use medications such as dapagliflozin and canagliflozin to lower blood
sugar levels in patients with type 2 diabetes mellitus.
Web photo retrieved from https://www.medindia.net/patients/patientinfo/glycosuria.htm

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Prevention strategies – live a healthy and
active lifestyle
Web photo retrieved from https://health.spectator.co.uk/regular-running-may-change-brain-works/
• Monitor diet and consume less sugar
• Conduct regular checkups for health status and any pre-existing
conditions such as diabetes and hyperthyroidism

12. Condition of excessive calcium in the
blood, hypercalcemia
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 Causes
 Signs and symptoms
 Diagnosis
 Treatment
 Prevention strategies

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The most common causes of excessive blood calcium
Web photos retrieved from https://www.sterlingcare.com/resources/resources/diseases-and-conditions-library/view/understanding-
hyperparathyroidism/ and http://www.sensipar.com/whats-secondary-hpt/
• Hyperparathyroidism, an overproduction of
parathyroid hormone (PTH), which is more
common in women over 50
• Benign tumors such as parathyroid adenoma
• Malignant tumors/cancers, especially lung
cancer and breast cancer
• Immobilization over a long period of time
• Kidney failure
• Overactive thyroid (hyperthyroidism) or
excessive thyroid hormone intake
• Certain medications such as the thiazide
diuretics
• Inherited kidney or metabolic conditions
• Excessive vitamin D levels from vitamins,
excessive dietary calcium, or from diseases
that may result in excess vitamin D production

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Signs and symptoms
Web photos retrieved from https://www.istockphoto.com/vector/peptic-ulcer-disease-stomach-ulcer-or-gastric-ulcer-gm645454524-117094053
and https://www.medicinenet.com/kidney_stones/article.htm
Cardiovascular conditions
• Higher levels of calcium in the blood.
• Abnormal heart rhythms
Moans (gastrointestinal conditions)
• Constipation
• Nausea
• Vomiting
• Loss of appetite
• Abdominal pain
• Peptic ulcer disease
Stones (kidney-related conditions)
• Kidney stones
• Flank pain
• Frequent urination

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Signs and symptoms
Web photos retrieved from http://www.dailymail.co.uk/health/article-2056905/At-GPs-told-MUST-check-brittle-bones-victory-osteoporosis-
campaigners.html and http://www.coloradoarthritis.com/osteoperosis-treatment-englewood.html
Groans (psychological conditions)
• Confusion
• Dementia
• Memory loss
• Depression
Bones and muscles (musculoskeletal
conditions)
• Muscle weakness
• Bone aches and joint pains
• Osteoporosis (fragile bones)
• Decreased bone density
• Spontaneous fractures or deformities
• Curving of the spine and loss of height

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Diagnosis
• Hypercalcemia is easy to be diagnosed as the calcium level in a
blood sample can be easily measured. The normal range of the blood
calcium is 8.6-10.3 mg/dL.
• To identify the causes of hypercalcemia needs a detailed history and
physical examination, including further blood tests (such as a PTH
level and vitamin D level), urine evaluation, X-rays, and other
imaging procedures.
Web photo retrieved from https://www.healththoroughfare.com/disease/high-levels-calcium-blood-dont-always-indicate-cancer/2520

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Treatment
• It the blood calcium is elevated to a critically high level to cause severe,
dangerous symptoms, the patient needs hospitalization and the use of hydration,
steroids, or even dialysis. Intravenous medications can be used to lower calcium.
• If the hypercalcemia is modest, treatment with medications can be administered
on an outpatient basis.
• If the underlying cause is hyperparathyroidism (particularly from an adenoma),
there are certain criteria to determine if a surgery is necessary, including the
absolute calcium level, a history of kidney stones or other calcium-related
complications, and the amount of calcium seen in a 24-hour urine collection.
Web photo retrieved from https://www.youtube.com/watch?v=6a3DptpfLmc

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Prevention strategies
Web photo retrieved from https://www.medindia.net/patientinfo/hypercalcemia.htm /
• Hypercalcemia cannot be prevented.
• Early detection is essential for normalization of blood calcium
levels and early definition of the cause.
• Special attention is required for any known family history of
hypercalcemia or hyperparathyroidism

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References
1. Glycosuria (glucose in urine) symptoms, causes, and potential complications,
https://www.belmarrahealth.com/glycosuria-glucose-urine-symptoms-causes-
potential-complications/.
2. Glycosuria, https://www.medindia.net/patients/patientinfo/glycosuria.htm.
3. Hypercalcemia (Elevated Calcium Levels),
https://www.medicinenet.com/hypercalcemia/article.htm.

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