DUTCH Complete™

Sometimes patients do not collect samples correctly or don't capture the scenario they were hoping to measure. New collection kits are free, and shipping fees are only applied to international or next-day delivery (standard shipping is free). Patients can simply call customer service to get a new collection kit and try again.

Once the test begins, patients can drink up to 40 ounces from the first afternoon sample collection (around 5:00 PM) until the next first morning void sample (waking sample). If limiting fluid intake to 40 ounces is challenging, then fluid intake may be increased to no more than 48 ounces. If more fluids are needed (due to heat, exercise, etc.) an individual may drink 8 ounces of fluids AFTER collecting the first morning void. After the second morning collection, fluids do not need to be restricted UNTIL two hours prior to the dinnertime sample. Between the dinnertime and bedtime samples, fluids need to be limited to no more than 8 ounces of fluids. Please ensure that the patient drinks the recommended amounts to ensure yellow, but not dark yellow, urine.

If too much fluid is consumed the urine may become too dilute and DUTCH results may be inaccurate. To assess this (and to calibrate for individual excretion) urine creatinine levels in the urine are measured. If creatinine values are too low (<0.15mg/mL in females and <0.20mg/mL in males) accurate creatinine correction may not occur. In this setting, interpret the results cautiously because cortisol and cortisol metabolites may be falsely elevated. If creatinine is 0 then there are no detectable urine hormones to test in the sample.

Patients should follow their normal daily routine. If caffeine is regularly consumed, then stopped for testing, there can be caffeine withdrawal that may spike cortisol that day. If the goal is to assess baseline cortisol levels without the influence of caffeine, avoid caffeine until AFTER the second morning urine collection. Alternately, if caffeine is not regularly consumed, but is consumed on the day of testing, results may reflect higher cortisol levels.

Alcohol can disrupt sleep, possibly raising cortisol levels. It can also affect estrogen metabolism. If alcohol is only consumed occasionally, it is best to avoid during DUTCH testing, so the results reflect typical cortisol and cortisol metabolism patterns. However, if a patient is consuming alcohol daily, DUTCH results would reflect daily alcohol consumption.

As long as urine can be held in the bladder for two hours prior to each sample collection, results should be accurate. If a patient needs to urinate during the night, the patient needs to collect this urine sample on the included “insomnia” collection strip to ensure accurate cortisol and melatonin results. If a patient requires multiple trips to the restroom during the night to urinate, urine should be collected each time using a single clean container kept in the refrigerator. The next morning, the patient should dip the overnight strip into the refrigerated container and then set out to dry.

*It is important to note that this method has not been validated.

Melatonin is produced throughout the night and metabolized quickly into a water-soluble metabolite that is excreted in urine. Melatonin production peaks somewhere between 3 AM and 4 AM depending on sleep and daylight exposure. The first-morning urine sample reflects overnight melatonin production. If a patient wakes during the night, they should collect a saliva sample (if doing a DUTCH Plus®) or collect a urine sample (if doing a DUTCH Complete™). The next first-morning void, regardless of a middle-of-the-night collection, will accurately represent the overnight melatonin levels, because internal research shows no significant difference with this method.