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Original article REFERENCES 1 2 3
Crawford A. An audit of the patient’s experience of arterial blood gas testing. Br J Nurs 2004;13:529–32. Sabin S, Taylor JR, Kaplan AI. Clinical experience using a small-gauge needle for arterial puncture. Chest 1976;69:437–9. Giner J, Casan P, Belda J, et al. Pain during arterial puncture. Chest 1996;110:1443–5.
4 5 6 7
Cepada MS, Afriacano JM, Polo R, et al. What decline in pain intensity is meaningful to patients with acute pain? Pain 2003;105:151–7. Kelly AM. The minimum clinically significant difference in visual analogue scale pain score does not differ with severity of pain. Emerg Med J 2001;18:205–7. Gyman CO, Wulbrecht PH. The safety of brachial artery puncture for arterial blood sampling. Chest 1998;114:748–51. Mortensen JD. Clinical sequelae from arterial needle puncture, cannulation & incision. Circulation 1967;35:1118–23.
IMAGES IN EMERGENCY MEDICINE
Purple urine bag syndrome A seventy-nine-year-old bedridden female patient presented to emergency with shortness of breath. She had an indwelling urinary catheter and decubitus ulcers. Her carer said the urine in the urethral catheter was purple coloured for the past 3 weeks (figure 1). Urinary dipstick analysis showed presence of large leucocytes, positive nitrates and pH of 8.5, protein +3, glucose negative, bilirubin negative, ketone± and erythrocyte was negative. She was hospitalised for urosepsis. The urine culture produced Escherichia coli 100 000 kou/mL. Purple coloured urine syndrome is most common in patients with permanent urinary polyvinyl chloride catheterisation, either urethral or supra pubic, in combination with a highly alkaline urinary tract infection.1 Responsible organisms for the purple urine bag (PUB) include Providencia bacteria, E. coli, Proteus mirabilis, Klebsiella pneumonie, Morganella morganii and Pseudomonas aeruginosa, and prevalence was 9.8%.2 Tryptophan in the diet is metabolised to indole which is absorbed into the portal system and converted to indicant by the liver. Also, indol is converted by indoxyl sulfate in alkaline urine by some bacterias into the red and blue coloured compounds, indirubin and indigo (figure 2).3 Special investigations should not be undertaken. Feriyde Çalişkan Tür,1 Nur Zafer,1 Nil Hocaoglu2 1
Department of Emergency Medicine, S.B. Izmir Tepecik Research and Training Hospital, İzmir, Turkey 2 Department of Pharmacology, Dokuz Eylül University Medical School, Izmir, Turkey
Figure 2 Indoxyl sulfate is converted by tryptofan in the urine into the red and blue coloured compounds indirubin and indigo. Correspondence to Dr Feriyde Çalışkan Tür, Department of Emergency Medicine, S.B. Izmir Tepecik Research and Training Hospital, Izmir 035100, Turkey; [email protected] Contributors FÇT: Concept and design and data collection, revision and approval of article; NHA: data collection, critical revision of article; NZ: data collection from patient. Competing interests None. Patient consent Obtained. Ethics approval Abdomen. Provenance and peer review Not commissioned; internally peer reviewed. ▸ Additional material is published online. To view please visit the journal (http://dx. doi.org/10.1136/emermed-2014-203818).
To cite Tür FeriydeÇşkan, Zafer N, Hocaoglu N. Emerg Med J 2015;32:347. Received 26 March 2014 Revised 21 April 2014 Accepted 25 April 2014 Published Online First 29 May 2014 Emerg Med J 2015;32:347. doi:10.1136/emermed-2014-203818
REFERENCES 1 2 3
Figure 1 Purple coloured urine was consistent throughout the bag and extended to the urinary catheter. Yee K, et al. Emerg Med J 2015;32:343–347. doi:10.1136/emermed-2014-203600
Harun NS, Nainar SK, Chong VH. Purple urine bag syndrome: a rare and interesting phenomenon. South Med J 2007;100:1048–50. Lin CH, Huang HT, Chien CC, et al. Purple urine bag syndrome in nursing homes: ten elderly case reports and a literature review. Clin Interv Aging 2008;3:729–34. Dealler SF, Hawkey PM, Millar MR. Enzymatic degradation of urinary indoxyl sulfate by Providencia stuartii and Klebsiella pneumoniae causes the purple urine bag syndrome. J Clin Microbiol 1988;26:2152–6.
347
Downloaded from http://emj.bmj.com/ on November 14, 2015 - Published by group.bmj.com
Purple urine bag syndrome Feriyde Çaliskan Tür, Nur Zafer and Nil Hocaoglu Emerg Med J 2015 32: 347 originally published online May 29, 2014
doi: 10.1136/emermed-2014-203818 Updated information and services can be found at: http://emj.bmj.com/content/32/5/347
These include:
Supplementary Supplementary material can be found at: Material http://emj.bmj.com/content/suppl/2014/05/29/emermed-2014-203818. DC1.html
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Topic Collections
This article cites 3 articles, 1 of which you can access for free at: http://emj.bmj.com/content/32/5/347#BIBL Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Articles on similar topics can be found in the following collections Urinary tract infections (25) Urinary tract infections (25) Ethics (375) Drugs: infectious diseases (269) Adult intensive care (169) Dermatology (88)
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
Original article REFERENCES 1 2 3
Crawford A. An audit of the patient’s experience of arterial blood gas testing. Br J Nurs 2004;13:529–32. Sabin S, Taylor JR, Kaplan AI. Clinical experience using a small-gauge needle for arterial puncture. Chest 1976;69:437–9. Giner J, Casan P, Belda J, et al. Pain during arterial puncture. Chest 1996;110:1443–5.
4 5 6 7
Cepada MS, Afriacano JM, Polo R, et al. What decline in pain intensity is meaningful to patients with acute pain? Pain 2003;105:151–7. Kelly AM. The minimum clinically significant difference in visual analogue scale pain score does not differ with severity of pain. Emerg Med J 2001;18:205–7. Gyman CO, Wulbrecht PH. The safety of brachial artery puncture for arterial blood sampling. Chest 1998;114:748–51. Mortensen JD. Clinical sequelae from arterial needle puncture, cannulation & incision. Circulation 1967;35:1118–23.
IMAGES IN EMERGENCY MEDICINE
Purple urine bag syndrome A seventy-nine-year-old bedridden female patient presented to emergency with shortness of breath. She had an indwelling urinary catheter and decubitus ulcers. Her carer said the urine in the urethral catheter was purple coloured for the past 3 weeks (figure 1). Urinary dipstick analysis showed presence of large leucocytes, positive nitrates and pH of 8.5, protein +3, glucose negative, bilirubin negative, ketone± and erythrocyte was negative. She was hospitalised for urosepsis. The urine culture produced Escherichia coli 100 000 kou/mL. Purple coloured urine syndrome is most common in patients with permanent urinary polyvinyl chloride catheterisation, either urethral or supra pubic, in combination with a highly alkaline urinary tract infection.1 Responsible organisms for the purple urine bag (PUB) include Providencia bacteria, E. coli, Proteus mirabilis, Klebsiella pneumonie, Morganella morganii and Pseudomonas aeruginosa, and prevalence was 9.8%.2 Tryptophan in the diet is metabolised to indole which is absorbed into the portal system and converted to indicant by the liver. Also, indol is converted by indoxyl sulfate in alkaline urine by some bacterias into the red and blue coloured compounds, indirubin and indigo (figure 2).3 Special investigations should not be undertaken. Feriyde Çalişkan Tür,1 Nur Zafer,1 Nil Hocaoglu2 1
Department of Emergency Medicine, S.B. Izmir Tepecik Research and Training Hospital, İzmir, Turkey 2 Department of Pharmacology, Dokuz Eylül University Medical School, Izmir, Turkey
Figure 2 Indoxyl sulfate is converted by tryptofan in the urine into the red and blue coloured compounds indirubin and indigo. Correspondence to Dr Feriyde Çalışkan Tür, Department of Emergency Medicine, S.B. Izmir Tepecik Research and Training Hospital, Izmir 035100, Turkey; [email protected] Contributors FÇT: Concept and design and data collection, revision and approval of article; NHA: data collection, critical revision of article; NZ: data collection from patient. Competing interests None. Patient consent Obtained. Ethics approval Abdomen. Provenance and peer review Not commissioned; internally peer reviewed. ▸ Additional material is published online. To view please visit the journal (http://dx. doi.org/10.1136/emermed-2014-203818).
To cite Tür FeriydeÇşkan, Zafer N, Hocaoglu N. Emerg Med J 2015;32:347. Received 26 March 2014 Revised 21 April 2014 Accepted 25 April 2014 Published Online First 29 May 2014 Emerg Med J 2015;32:347. doi:10.1136/emermed-2014-203818
REFERENCES 1 2 3
Figure 1 Purple coloured urine was consistent throughout the bag and extended to the urinary catheter. Yee K, et al. Emerg Med J 2015;32:343–347. doi:10.1136/emermed-2014-203600
Harun NS, Nainar SK, Chong VH. Purple urine bag syndrome: a rare and interesting phenomenon. South Med J 2007;100:1048–50. Lin CH, Huang HT, Chien CC, et al. Purple urine bag syndrome in nursing homes: ten elderly case reports and a literature review. Clin Interv Aging 2008;3:729–34. Dealler SF, Hawkey PM, Millar MR. Enzymatic degradation of urinary indoxyl sulfate by Providencia stuartii and Klebsiella pneumoniae causes the purple urine bag syndrome. J Clin Microbiol 1988;26:2152–6.
347
Downloaded from http://emj.bmj.com/ on November 14, 2015 - Published by group.bmj.com
Purple urine bag syndrome Feriyde Çaliskan Tür, Nur Zafer and Nil Hocaoglu Emerg Med J 2015 32: 347 originally published online May 29, 2014
doi: 10.1136/emermed-2014-203818 Updated information and services can be found at: http://emj.bmj.com/content/32/5/347
These include:
Supplementary Supplementary material can be found at: Material http://emj.bmj.com/content/suppl/2014/05/29/emermed-2014-203818. DC1.html
References Email alerting service
Topic Collections
This article cites 3 articles, 1 of which you can access for free at: http://emj.bmj.com/content/32/5/347#BIBL Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Articles on similar topics can be found in the following collections Urinary tract infections (25) Urinary tract infections (25) Ethics (375) Drugs: infectious diseases (269) Adult intensive care (169) Dermatology (88)
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
