CLINICAL IMAGE
Green urine Abhilash Koratala
& Muhannad Leghrouz
Division of Nephrology, Hypertension and Renal Transplantation, University of Florida, Gainesville, Florida, USA
Correspondence Abhilash Koratala, College of Medicine/UF Health, 1600 SW Archer rd, Room CG 98, Communicore building, Gainesville, FL 32610, USA. Tel: 352-294-8694; Fax: 352392-3581; E-mail: [email protected]
Funding Information No sources of funding were declared for this study.
Key Clinical Message Methylene blue is used to assess the integrity of the bowel and may cause selflimiting bluish or greenish hue to the urine. Green urine is also caused by medications such as propofol and infections such as pseudomonas. Knowledge of the benign nature of this condition prevents unnecessary consultations and anxiety. Keywords Green urine, methylene blue, propofol, pseudomonas.
Received: 6 January 2017; Accepted: 9 February 2017 Clinical Case Reports 2017; 5(4): 549–550 doi: 10.1002/ccr3.891
Case Description A 62-year-old woman was admitted to the hospital for perforated gastric ulcer and underwent emergent exploratory laparotomy with repair of the perforation. She was intubated and sedated using fentanyl. During
(A)
(B)
follow-up evaluation, she received methylene blue through nasogastric tube to test for integrity of the gastric wall. Subsequently, her urine was noted to be green (Fig. 1A), which gradually faded over a period of 5 days (Fig. 1B and C). Methylene blue is a watersoluble dye commonly used as a diagnostic aid to assess
(C)
Figure 1. (A) Green urine on the day of methylene blue administration (B and C) fading color of the urine over next few days. ª 2017 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
549
Green urine
integrity of the bowel or used as a therapeutic agent in conditions such as ifosfamide-induced encephalopathy [1] and methemoglobinemia. It is filtered by the kidneys and has no pathologic effects but may cause the urine to have a bluish or greenish hue that is self-limiting [2]. Other known causes of green urine include indigo, Pseudomonas infection, drugs such as propofol, cimetidine, amitriptyline, promethazine, and indomethacin.
Conflict of Interest The authors have declared that no conflict of interest exists.
550
A. Koratala & M. Leghrouz
Authorship Both the authors made substantial contribution to the preparation of this manuscript and approved the final version for submission. AK: drafted the manuscript. ML: acquired the images and other pertinent patient data. References 1. Turner, A. R., C. D. Duong, and D. J. Good. 2003. Methylene blue for the treatment and prophylaxis of ifosfamide-induced encephalopathy. Clin. Oncol. (R. Coll. Radiol.) 15:435–439. 2. Stratta, P., and M. C. Barbe. 2008. Images in clinical medicine. Green urine. N. Engl. J. Med. 358:e12.
ª 2017 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.
Green urine Abhilash Koratala
& Muhannad Leghrouz
Division of Nephrology, Hypertension and Renal Transplantation, University of Florida, Gainesville, Florida, USA
Correspondence Abhilash Koratala, College of Medicine/UF Health, 1600 SW Archer rd, Room CG 98, Communicore building, Gainesville, FL 32610, USA. Tel: 352-294-8694; Fax: 352392-3581; E-mail: [email protected]
Funding Information No sources of funding were declared for this study.
Key Clinical Message Methylene blue is used to assess the integrity of the bowel and may cause selflimiting bluish or greenish hue to the urine. Green urine is also caused by medications such as propofol and infections such as pseudomonas. Knowledge of the benign nature of this condition prevents unnecessary consultations and anxiety. Keywords Green urine, methylene blue, propofol, pseudomonas.
Received: 6 January 2017; Accepted: 9 February 2017 Clinical Case Reports 2017; 5(4): 549–550 doi: 10.1002/ccr3.891
Case Description A 62-year-old woman was admitted to the hospital for perforated gastric ulcer and underwent emergent exploratory laparotomy with repair of the perforation. She was intubated and sedated using fentanyl. During
(A)
(B)
follow-up evaluation, she received methylene blue through nasogastric tube to test for integrity of the gastric wall. Subsequently, her urine was noted to be green (Fig. 1A), which gradually faded over a period of 5 days (Fig. 1B and C). Methylene blue is a watersoluble dye commonly used as a diagnostic aid to assess
(C)
Figure 1. (A) Green urine on the day of methylene blue administration (B and C) fading color of the urine over next few days. ª 2017 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
549
Green urine
integrity of the bowel or used as a therapeutic agent in conditions such as ifosfamide-induced encephalopathy [1] and methemoglobinemia. It is filtered by the kidneys and has no pathologic effects but may cause the urine to have a bluish or greenish hue that is self-limiting [2]. Other known causes of green urine include indigo, Pseudomonas infection, drugs such as propofol, cimetidine, amitriptyline, promethazine, and indomethacin.
Conflict of Interest The authors have declared that no conflict of interest exists.
550
A. Koratala & M. Leghrouz
Authorship Both the authors made substantial contribution to the preparation of this manuscript and approved the final version for submission. AK: drafted the manuscript. ML: acquired the images and other pertinent patient data. References 1. Turner, A. R., C. D. Duong, and D. J. Good. 2003. Methylene blue for the treatment and prophylaxis of ifosfamide-induced encephalopathy. Clin. Oncol. (R. Coll. Radiol.) 15:435–439. 2. Stratta, P., and M. C. Barbe. 2008. Images in clinical medicine. Green urine. N. Engl. J. Med. 358:e12.
ª 2017 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.
