Urine Colour • LITFL • CCC Investigations

Normally, urine is some shade of yellow with acid urine usually a darker colour than alkaline urine. Pathologically, it may be any colour.

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Colour	Causes
Green	Drugs: Cimetidine, Promethazine, Amitriptyline, Flutamide, Indomethacin, Methocarbamol, Methylene blue, Mitoxantrone, Propofol, Phenylbutazone, Triamterene Condition: Hartnup Disease, Indicanemia, Indicanuria Infection: Pseudomonas Infection Dyes: Carbolic Acid, Flavine derivatives, Indigo Blue, Methylene Blue, Resorcinol Other: Clorets, Listerine, Magnesium Salicylate, Asparagus Case: Verdant waste Case: How Green is my urine
Orange	Drugs: Idarubicin, Ferrioxamine, Oxamniquine, Phenazopyridine, Rifampicin, Sulfasalazine, Warfarin Food/supplements: Carotenes, B-complex vitamins, Senna, Rhubarb, Beets and blackberries Condition (hypercarotenemia): Diabetes mellitus, hyperlipidemia, hypothyroidism, porphyria Case: Where are the lemons?
Red	Stones: (calculi in the renal pelvis, ureter or bladder) Malignancy: TCC, RCC, Wilms Trauma: Blunt or penetrating trauma to the abdomen or pelvis; a catheter will commonly cause haematuria. BPH is a common cause of intermittent gross haematuria Renal: Primary renal disease (e.g. glomerulonephritis; including IgA-related, membranous, mesangiocapillary, focal and minimal change). Renal disease associated with / due to / secondary to systemic vasculitis (e.g. SLE, polyarteritis nodosa), Papillary necrosis secondary to analgesic nephropathy or diabetic nephrosclerosis. Hereditary (e.g. Alport’s syndrome). Infection: Pyelonephritis, UTI, pyonephrosis, cystitis, prostatitis, TB, schistosomiasis Coagulopathy: Anticoagulation, Inherited defect (e.g. haemophilia, Von Willebrand’s), Acquired defect (e.g. DIC, thrombocytopenia).
Red-Brown	Drugs: Levadopa, nitrofurantoin, metronidazole Condition: Rhabdomyolosis (myoglobinuria), bile pigment Other: Fava beans Case: Mahogany Myoglobinuria
Cherry red / Raspberry	Drug: Hydroxocobalamin, Sodium nitroprusside; amino-salicyclic acid derivatives – mesalazine/paraaminosalycylic acid/sulfasalazine; doxorubicin, ibuprofen, phenothiazines, phenolphthalein, propofol, rifampicin/rifampin Diet: Beeturia, rhubarb, blackberries, food dyes Condition: Cyanide toxicity; porphyria, urate crystals Case: Raspberry urine?
Purple	Infection: Bacteria such as Providencia stuartii, Klebsiella pneumoniae, P. aeruginosa, Escherichia coli, and enterococcus species. Condition: Hartnup Disease, Indicanemia, Indicanuria Case: Tyrian Rage
Black	Drugs: Stimulant laxatives (e.g. cascara, senna) Condition: Alkaptonuria, methemoglobinuria Other: Melanin Case: Brown/Black urine
Milky	Pyuria Case: Pyuria

References and Links

Unusual urine – Clinical Cases
CCC – Urinalysis
CCC – Urine electrolytes – Urinary anion gap
Urinalysis Overview Table

CCC Differential Diagnosis Series
NEURO	Anosmia, Ataxia, Blepharospasm, Bulbar and Pseudobulbar palsy, Central Pontine Myelinosis, Cerebellar Disease, Chorea, Cranial nerve lesions, Dementia, Dystonia, Exophthalmos, Eye trauma, Facial twitches, Fixed dilated pupil, Horner syndrome, Loss of vision, Meningism, Movement disorders, Optic disc abnormality, Parkinsonism, Peripheral neuropathy, Radiculopathy, Red eye, Retinal Haemorrhage, Seizures, Sudden severe headache, Tremor, Tunnel vision
RESP	Bronchial breath sounds, Bronchiectasis, High airway pressures, Massive haemoptysis, Sore throat, Tracheal displacement
CVS	Atrial Fibrillation, Bradycardia, Cardiac Failure, Chest Pain, Murmurs, Post-resuscitation syndrome, Pulseless Electrical Activity (PEA), Pulsus Paradoxus, Shock, Supraventricular tachycardia (SVT), Tachycardia, VT and VF, SVC Obstruction
GIT	Abdominal distension, Abdominal mass, Abdominal pain, Asterixis, Dysphagia, Hepatomegaly, Hepatosplenomegaly, Large bowel obstruction, Liver palpation abnormalities, Lower GI haemorrhage, Malabsorption, Medical causes of abdominal pain, Rectal mass, Small bowel obstruction, Upper GI Haemorrhage
GUT	Genital ulcers, Groin lump, Scrotal mass, Urine colour, Urine Odour, Urine transparency,
MSK	Arthritis, Shoulder pain, Wasting of the small muscles of the hand
DERM	Palmar erythema, Serious skin signs in sick patients, Thickened Tethered Skin, Leg ulcers, Skin Tumour, Acanthosis Nigricans
ENDO	Diabetes Insipidus, Diffuse Goitre, Gynaecomastia, Hirsutism, Hypoglycaemia, SIADH, Weight Loss
HAEM	Splenomegaly
PAEDS	Floppy infant
MISC	Anaphylaxis, Autoimmune associated diseases, Clubbing, Parotid Swelling, Splinter haemorrhages, Toxic agents and abnormal vitals, Toxicological causes of cardiac arrest
IMAGING	CHEST: Atelectasis, Hilar adenopathy, Hilar enlargement on CXR, Honeycomb lung, Increased interstitial markings, Mediastinal widening on mobile CXR, Pulmonary fibrosis, Pseudoinfiltrates on CXR, Pulmonary opacities on CXR, ABDO: Gas on abdominal X-ray, Kidney mass, BRAIN: Intracranial calcification, Intracranial structures with contrast, Ventriculomegaly, OTHER: Pseudofracture on X-Ray,
LABS	LOW: Anaemia, Hypocalcaemia, hypochloraemia, Hypomagnesaemia, HIGH: Bilirubin and Jaundice, Hyperammonaemia, Hypercalcaemia, Hyperchloraemia, Hyperkalaemia, Hypermagnesaemia, ACID BASE: Acid base disorders, Resp. acidosis, Resp. alkalosis, Creatinine, CRP, Dipstick Urinalysis, Laboratory Urinalysis, Liver function tests (LFTs), Pleural fluid analysis, Urea, Urea Creatinine Ratio, Uric acid, Urinalysis, Urine Electrolytes

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Mike Cadogan

BA MA (Oxon) MBChB (Edin) FACEM FFSEM. Associate Professor Curtin Medical School, Curtin University. Emergency physician, Sir Charles Gairdner Hospital. 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 |

Jeremy Rogers

Physician in training. German translator and lover of medical history.

References and Links

Critical Care

Mike Cadogan

Jeremy Rogers

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