A nurse in a pediatric clinic is reviewing the urine laboratory results for an adolescent. For which of the following results should the nurse notify the provider?

A. Nitrites negative: Nitrites in the urine are typically produced by certain gram-negative bacteria that convert nitrates to nitrites. A negative nitrite result suggests the absence of common bacterial urinary tract infection pathogens and is considered a normal finding. B. Ketones positive: Positive urinary ketones indicate fat breakdown and possible metabolic imbalance. In adolescents, this may be associated with uncontrolled diabetes mellitus, prolonged fasting, eating disorders, or dehydration. The presence of ketones raises concern for diabetic ketoacidosis if accompanied by hyperglycemia, making provider notification necessary. C. Uric acid 475 mg/24 hr: Normal 24-hour urinary uric acid excretion typically ranges from approximately 250 to 750 mg. A value of 475 mg/24 hr falls within expected limits and does not indicate metabolic or renal dysfunction requiring intervention. D. Specific gravity 1.020: Normal urine specific gravity ranges from about 1.005 to 1.030, reflecting appropriate renal concentrating ability. A value of 1.020 indicates adequate hydration and kidney function, and it does not suggest pathology requiring provider notification.