aka Unusual Urine 003
What is the cause of this green urine?
What is the significance of this happening?
- This phenomenon usually occurs in the setting of propofol being administered by infusion in at least a moderately high dose.
- However, it is a benign phenomenon and is not thought to be associated with an increased risk of propofol infusion syndrome or other badness.
What is propofol infusion syndrome?
- Cardiac dysfunction – especially arrhythmia (such as sudden onset of marked bradycardia resistant to treatment, leading to asystole) and hypotension
and one of:
- Acute renal failure
Although other features may also be present:
- Unexplained metabolic acidosis
- Lactic acidosis
The mechanism for PRIS remains obscure as does its true incidence.
Can the onset of propofol infusion syndrome be predicted?
- Routine monitoring for biochemical markers such as serum lactate, creatine kinase, myoglobin, and triglycerides has been advocated for early detection of PRIS.
- However, even twice-daily evaluations of these laboratory studies – with immediate discontinuation ofpropofol if derangements are detected – may not be protective.
- Nevertheless, early discontinuation ofpropofol may lead to recovery.
- The development of a Brugada-like ECG pattern (right bundle branch block with convex-curved ST segment elevation in the right precordial leads) has been noted in some cases of PRIS but the utility of this finding is unclear.
- 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]
- The Art of Observation (particularly Urine) – Smith, Bell, and the Art of Observation
- LITFL: Distick Urinalysis Review and Overview table
- LITFL: Urine Colour Review
- LITFL: Urine Transparency
LITFL Further Reading