Black urine due to urobilinogen in a patient with alcoholic pellagra

Chindarkar, Nandkishor S.; Rentmeester, Landen L.; Ly, Binh T.; Fitzgerald, Robert L.

doi:10.1016/j.clinbiochem.2014.03.016

Cited by 3 publications

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References 13 publications

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“…Urine discoloration caused by chemicals or drugs is an important clinical symptom that indicates a potentially dangerous condition, which may also be disturbing for patients and clinicians ( Chindarkar et al, 2014 ). Propofol (2,6-diisopropylphenol) is a commonly used intravenous anesthetic and sedative agent administered during surgery and in intensive care units ( Wang et al, 2019 ).…”

Section: Introductionmentioning

confidence: 99%

Case Report: Pink Urine Syndrome Following Exposure to Propofol: A Rare, Impressive but Benign Complication

et al. 2021

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Drug-induced changes in urine color induced by drugs may have clinical significance. Pink urine syndrome (PUS), which has been associated with urinary uric acid (UA) disorders, is most frequently reported in patients with morbid obesity undergoing gastric bypass surgery and/or from propofol anesthesia use in those who potentially have preexisting UA metabolism disorders. However, PUS has rarely occurred following exposure to propofol in non-obese patients, and literature on long-term follow-up after PUS is scarce. We report a case of PUS induced by propofol in a previously healthy non-obese woman after undergoing thoracoscopic wedge resection of pulmonary nodules under general anesthesia using propofol. The patient suddenly developed pink urine 4 h after surgery. A pink sediment rapidly precipitated at the bottom of the test tube following centrifugation of the urine. Amorphous, colorless UA-like crystals were identified under a polarizing microscope. The diagnosis of PUS was confirmed by examining the urinary UA concentration. The patient recovered and as followed-up for 1 month, during which she did not experience any urinary complications. To our knowledge, this is the first report to describe in detail a case of PUS caused by propofol in a non-obese patient with follow-up. PUS is usually benign and can resolve by rapidly on administering lactated Ringer’s solution; however, the potential risk of urinary complications, particularly UA lithiasis, should be fully realized.

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Section: Introductionmentioning

confidence: 99%

Case Report: Pink Urine Syndrome Following Exposure to Propofol: A Rare, Impressive but Benign Complication

et al. 2021

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Atypical presentation of pellagra with black urine: A clinical conundrum

Munagama,

Silva

2024

SAGE Open Medical Case Reports

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Niacin (Vitamin B3) plays a crucial role as a vitamin in cellular energy production, metabolism, and DNA repair. A severe deficiency of this vitamin can lead to pellagra, which is characterized by dermatitis, dementia, diarrhoea and eventually death if untreated. A 68-year-old woman with a poor socioeconomic background presented with photosensitive dermatitis, fever, abdominal pain, and diarrhoea. Her urine changed to port wine colour following sun exposure. Porphyria cutanea tarda was excluded in the absence of demonstrable urine spectrophotometry. A diagnosis of pellagra was made, and timely management led to a complete cure. Proper diagnosis and effective treatment of pellagra are imperative as this condition can be life-threatening if left untreated.

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Green urine

Sun

Huang

2018

CMAJ

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A n 85-year-old woman was brought to the emergency department after she was found on the floor of her bedroom with generalized weakness and confusion. Her medical history was noteworthy for coronary artery disease, type 2 diabetes and atrial fibrillation. She was taking diltiazem, sitagliptin, pantoprazole, atorvastatin, bisoprolol and hydroxyzine. At the emergency department, the patient was febrile (body temperature 38.3°C), hypotensive (blood pressure 88/70 mmHg) and tachycardiac (heart rate 120 beats/min). We found a diffuse abdominal tenderness on palpation. A urinary catheter was inserted and it drained green-colured urine (Figure 1). The patient had a white blood cell count of 42.3 (normal range 4.0-11.0) × 10 9 /L, with neutrophils at 35.1 (normal range 2.0-7.5) × 10 9 /L and a serum creatinine level of 100 (normal range 62-102) µmol/L. Results from urinalysis showed a pH of 6.5 (normal range 5.0-8.5) with trace ketones, but no blood or leukocytes were found. Computed tomography of the abdomen showed a distended gallbladder with mild wall thickening that was suggestive of cholecystitis. We started treatment with broad spectrum antibiotics, and, after 24 hours, the patient had improved substantially and was no longer confused. On further history, she reported that she had undergone a colonoscopy with snare polypectomy in a different hospital the day before her admission. During the procedure, the physician had used submucosal saline injections containing methylene blue to elevated the polyp, which led to urine discolouration. Green-coloured urine has been reported with medications such as propofol, metoclopramide, methylene blue, Clorets breath fresheners and traditional Chinese medicines. 1-3 Purple urine caused by formation of pigments from dietary trypotophan by gram-negative bacteria has been reported. 4 Black urine, which stains the collection containers, can be seen with elevated urobilinogen. 5 Although urine colour can be a clue to diagnosis of diseases such as porphyria, a thorough history can often provide a diagnosis without invasive investigations. Abnormal urine colour can be distracting to the health care providers. In this case, it was not the cause of sepsis in this patient.

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Black urine due to urobilinogen in a patient with alcoholic pellagra

Abstract: The patient's abnormal laboratory results were explained by his alcoholism and poor nutrition. Furthermore, urine color returned to normal with decreased concentration of urobilinogen, after vitamin supplementation and supportive medical care.

Cited by 3 publications

References 13 publications

Case Report: Pink Urine Syndrome Following Exposure to Propofol: A Rare, Impressive but Benign Complication

Case Report: Pink Urine Syndrome Following Exposure to Propofol: A Rare, Impressive but Benign Complication

Atypical presentation of pellagra with black urine: A clinical conundrum

Green urine

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