How Green is my urine

aka Unusual Urine 002

Morning rounds can be fun sometimes…you never know what diagnostic conundrums and eponymous challenges you will face.

Casual perusal of the output from a patients indwelling catheter this morning provoked some consternation amongst the staff, but I have great faith that you will have little trouble in elucidating a comprehensive differential diagnosis for the unusual appearance of the depicted urethral elimination…


What is unusual about the appearance of the urine?

Unusual Answer

The urine is green!


What are some possible causes?

Unusual Answer

Causes of green urine include IV or oral administration of products containing phenol, chlorophyll or thymol

Drugs:

  • Cimetidine
  • Promethazine
  • Amitriptyline
  • Flutamide
  • Indomethacin
  • Methocarbamol
  • Methylene blue
  • Mitoxantrone
  • Propofol
  • Phenylbutazone
  • Triamterene

Consumer Products

  • Clorets
  • Listerine
  • Magnesium Salicylate
  • Asparagus

Dyes:

  • Carbolic Acid
  • Flavine derivatives
  • Indigo Blue
  • Methylene Blue
  • Resorcinol

Pathologic Conditions:

  • Pseudomonas Infection
  • Hartnup disease
  • Indicanemia and Indicanuria

References
  • 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]
  • Nickson C. The Art of Observation (particularly Urine). LITFL

CLINICAL CASES

Unusual Urine

Emergency physician MA (Oxon) MBChB (Edin) FACEM FFSEM with a passion for rugby; medical history; medical education; and asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | Twitter |

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