Q J Med 2015; 108:675 doi:10.1093/qjmed/hcv030
Advance Access Publication 31 January 2015
Clinical picture Green urine revealed no evidence of Pseudomonas infection throughout hospitalization. The medications given to the patient included fentanyl, omeprazole, ceftriaxone and propofol. All causes but propofol were excluded, and thus a diagnosis of propofolinduced green urine was established. It is presumed that phenolic green chromophore is conjugated in the liver and excreted in the urine, making the urine green.1–3 This propofol-associated discoloration is reversible with the discontinuation of propofol. Because propofol-induced green urine is benign and reversible, physicians should be aware of this phenomenon and avoid unnecessary tests. Photographs and text from: S. Urushidani, Department of Emergency Medicine, Kurashiki Central Hospital, 1-1-1 Miwa Kurashiki Okayama 710-8602, Japan; A. Kuriyama, Department of General Medicine, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan email: [email protected]
Acknowledgements The authors sincerely thank Ryoko Yoshida for editing the figure.
Patient Consent Written patient consent to publish the text and image was obtained from the patient. Conflict of interest: None declared.
References 1. Gillett MJ, Burnett JR. Medications and green urine. Intern Med J 2006; 36:64–6. 2. Leclercq P, Loly C, Delanaye P, Garweg C, Lambermont B. Green urine. Lancet 2009; 373:1462.
Figure 1. Green urine.
3. Tan CK, Lai CC, Cheng KC. Propofol-related green urine. Kidney Int 2008; 74:978.
! The Author 2015. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: [email protected]
Downloaded from by guest on November 14, 2015
A 72-year-old man with chronic hepatitis presented in a state of shock due to hemorrhagic gastric ulcer. He was intubated and sedated with propofol for the management of concurrent pneumonia, for which ceftriaxone was initiated. His urine gradually turned green within a few days (Figure 1). Hemodynamic and respiratory statuses were stabilized and the patient was subsequently extubated. The urine discoloration soon resolved. Known causes of green urine include indigo, biliverdin (an oxidation product of bilirubin), Pseudomonas infection, cimetidine and propofol.1 In this case, indigocarmine had not been administered for gastrointestinal endoscopy. Serum total bilirubin levels were normal, and sputum culture
Advance Access Publication 31 January 2015
Clinical picture Green urine revealed no evidence of Pseudomonas infection throughout hospitalization. The medications given to the patient included fentanyl, omeprazole, ceftriaxone and propofol. All causes but propofol were excluded, and thus a diagnosis of propofolinduced green urine was established. It is presumed that phenolic green chromophore is conjugated in the liver and excreted in the urine, making the urine green.1–3 This propofol-associated discoloration is reversible with the discontinuation of propofol. Because propofol-induced green urine is benign and reversible, physicians should be aware of this phenomenon and avoid unnecessary tests. Photographs and text from: S. Urushidani, Department of Emergency Medicine, Kurashiki Central Hospital, 1-1-1 Miwa Kurashiki Okayama 710-8602, Japan; A. Kuriyama, Department of General Medicine, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan email: [email protected]
Acknowledgements The authors sincerely thank Ryoko Yoshida for editing the figure.
Patient Consent Written patient consent to publish the text and image was obtained from the patient. Conflict of interest: None declared.
References 1. Gillett MJ, Burnett JR. Medications and green urine. Intern Med J 2006; 36:64–6. 2. Leclercq P, Loly C, Delanaye P, Garweg C, Lambermont B. Green urine. Lancet 2009; 373:1462.
Figure 1. Green urine.
3. Tan CK, Lai CC, Cheng KC. Propofol-related green urine. Kidney Int 2008; 74:978.
! The Author 2015. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: [email protected]
Downloaded from by guest on November 14, 2015
A 72-year-old man with chronic hepatitis presented in a state of shock due to hemorrhagic gastric ulcer. He was intubated and sedated with propofol for the management of concurrent pneumonia, for which ceftriaxone was initiated. His urine gradually turned green within a few days (Figure 1). Hemodynamic and respiratory statuses were stabilized and the patient was subsequently extubated. The urine discoloration soon resolved. Known causes of green urine include indigo, biliverdin (an oxidation product of bilirubin), Pseudomonas infection, cimetidine and propofol.1 In this case, indigocarmine had not been administered for gastrointestinal endoscopy. Serum total bilirubin levels were normal, and sputum culture
