Christmas-colored urine in vasoplegic shock

Excerpt

A 73-year-old male underwent redo mitral valve replacement. Cardiopulmonary bypass time was prolonged and the case was complicated by significant hypotension. He arrived to the ICU on multiple vasopressors in refractory vasoplegic shock. Methylene blue was administered and then high-dose hydroxocobalamin as salvage agents. These agents are nitric oxide scavengers and their use has increased in the treatment of vasoplegic syndrome. Both agents can cause benign changes to urine color. The patient’s urine was first noted to be green-blue as is commonly seen with methylene blue administration. After administration of hydroxocobalamin, urine color then changed to a maroon-red, also a known side effect of this medication, which can last for over a week. These distinct color changes were visualized in the foley bag, correlating with timing of administration (Fig. 1, black arrow). Over the next 24 h, shock improved and the patient was weaned off vasopressors and made a complete recovery.

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