aka Unusual Urine 002
Morning rounds can be fun sometimes…you never know what diagnostic conundrums and eponymous challenges you will face.
Casual perusal of the output from a patients indwelling catheter this morning provoked some consternation amongst the staff, but I have great faith that you will have little trouble in elucidating a comprehensive differential diagnosis for the unusual appearance of the depicted urethral elimination…
In case your mind is clouded with non-medical perturbations I have taken the liberty of outlining some of the more common causes below
Questions
What is unusual about the appearance of the urine?
The urine is green!
What are the possible causes?
Causes of green urine include IV or oral administration of products containing phenol, chlorophyll or thymol
- Drugs
- Cimetidine
- Promethazine
- Amitriptyline
- Flutamide
- Indomethacin
- Methocarbamol
- Methylene blue
- Mitoxantrone
- Propofol
- Phenylbutazone
- Triamterene
- Consumer Products
- Clorets
- Listerine
- Magnesium Salicylate
- Asparagus
- Dyes
- Carbolic Acid
- Flavine derivatives
- Indigo Blue
- Methylene Blue
- Resorcinol
- Pathologic Conditions
- Pseudomonas Infection
- Hartnup Disease
- Indicanemia and Indicanuria
References
- Riker RR, Glisic EK, & Fraser GL (2009). Propofol infusion syndrome: difficult to recognize, difficult to study. Critical care medicine, 37 (12), 3169-70 PMID: 19923937
- Iyer VN, Hoel R, & Rabinstein AA (2009). Propofol infusion syndrome in patients with refractory status epilepticus: an 11-year clinical experience. Critical care medicine, 37 (12), 3024-30 PMID: 19661801
About Mike Cadogan
I have most commonly see green urine associated with prolonged propofol sedation. In this case the virescent urinary hue was secondary to an overdose of Crème de menthe
Quite the sweet tooth. Any history of diabetes?
What was alcohol level?
Thanks Rogue
750mL of Crème de menthe with Alcohol level 0.35 on arrival
I’ve never seen green before, but pinky red yes. It happens in my children after they’ve consumed either cranberry or blackcurrant juice. And during blackberry season when we go picking, they have to sample a few … well, several actually. Ok, LOTS…!! I tell them I can count how many they’ve had by the colour of their urine. So far, they think I’m magic
Would have thought super green supplement foods like alfalfa, spirulina, etc. Crème de menthe…who would have known?! Nice cases you get over there.