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Unternavigation im Bereich: The Procedure

Answers to Frequently Asked Questions

We are often asked about the Ruma Marker-System and its practical application. Below please find answers to relevant questions that were posed in the past. We hope they also contribute to a better understanding of our procedure.

Please don't hesitate to contact us should you have any questions that are not answered below.

What do the patients do while they have to wait?

That depends on the preferences of the physicians and medical professionals: some of them use the waiting period for a physical examination or to talk with their patients. Others allow their patients to take care of personal things. In psychiatric facilities it is common practice to administer the marker in the evening so that the patient can collect the sample during the night or early in the morning (morning urine) by themselves and without supervision.

Will the results be affected by drinking lots of fluids before marker intake or during the waiting period?

As a rule of thumb: one liter (approx. 0.26 US gal) of water dillutes the urine by a factor of 10. The marker concentration falls below the cut off before the drugs turn negative. Many colleagues interpret heavily diluted urine as a manipulation attempt and treat it as such. For quality assurance purposes we always measure the urine creatinine concentration to verify such attempts.

It is good practice to have the patients use the restroom to void their bladder before administering the marker. This will ensure that the bladder is empty and that the patient will be able to wait the required 40 minutes.

How about diabetics?

Even controlled diabetics can take the marker in a beverage sweetened with household sugar.
However, it's also possible to take the marker without sugar. In this case, please make sure that there's no sponge or similar device in the mouth cavity to collect the marker substance and then add it to another urine at a later time. Have the patient rinse their mouth several times after they swallowed the marker.
Please note the lack of sugar intake on the lab slip!

What's the deal with the sugar, anyway?

Household sugar is cleaved in the body and thus doesn't normally occur in urine. Finding sugar in a urine sample suggests that the marker wasn't actually swallowed but spat into another person's urine sample. A bit of cotton or a small sponge is hidden in the mouth for that purpose.
If you need to make an exception and administer the marker without the sugar, have the patient rinse their mouth thoroughly after they drank the marker beverage. And please make a note of that on the lab slip.

The sugar itself has no effect at all on the mechanics of the marker substance.

What does the marker procedure cost for patients with German statutory health insurance?

For patients covered by German statutory health insurance, marker analysis is settled directly between us and the insurance provider. The physician adds the analysis to the lab referral, thus not incurring cost for themselves.

What are the suitable beverages?

You may use any beverage that you add 150 g/5.3 oz of household sugar to. Fruit tea or water have proven to be very useful. Please note that the 150 g/5.3 oz of sugar need to be added to any soda or juice as well, regardless of the amount or type of sweetener they may already contain.
Please also note that the exemption for regular Coca Cola no longer applies. After changes to the composition, the sugar content is no longer sufficient.

Is this a medication or drug?

No. The polyethylene glycols we use are neither medications nor medical devices or diagnostic agents. This has been confirmed by various agencies at an international level. Please refer to our download center for our statement of no-objection as well as corresponding documentation e.g. by EMA or FDA/CDER.

Are there any side effects?

No.

When will the marker be excreted completely?

In general, the marker is completely flushed out after 6 to 8 hours. If the patient cannot urinate in the meantime, the marker will remain in the urine. Always use only the first urine after administering the marker.

How is the marker stored?

Simply keep the tubes closed at room temperature until use. The marker solidifies when refrigerated but returns to its liquid state when the temperature is brough back up. It is sufficient to keep it in your hand and shake it a bit.

Can the marker spoil?

No.

How do I store the sample?

Please store the sample in your refrigerator or freezer until transport. Although the marker and its analysis are not affected when stored for weeks or months at room temperature, bacterial activity on the urine itself will interfere with the analysis.

How long is a sample stored for confirmation analysis?

In general, two weeks. Please refer to your partner lab if you need an extended time frame.

How long can the marker be detected in a sample?

If a longer storage period has been set up, our respective partner lab will keep the sample frozen. In this case, the marker will be detectable without time limit.

What manipulation attempts are there with the marker?

We have experienced two relevant types of manipulation attempts:
1). Swapping of marked urine samples
2). “Body Bypass”

Re. 1): We use different markers so that the patients cannot substitute or sell “marked urine” .

Re. 2): Some addiction patients keep a sponge in their mouth when they drink the marker fluid. It absorbs the marker which can then be added to a "clean" urine sample later. We administer the marker in heavily sugared beverages (fruit tea, etc.) to detect this since saccharose doesn't usually occur in urine. We analyze the urine for saccharose. We also analyze for the possible addition of substances that destroy sugar such as yeast.