- The passage of green or blue urine can be alarming but is usually a benign and reversible phenomenon. It may be caused by propofol (a commonly used intravenous anaesthetic), Hartnup disease, biliverdin, pyocyanin pigment from pseudomonas urinary infection, methylene blue, cimetidine, amitriptyline, indomethacin, or food coloring (Lancet 373:1462).
- Purple Urine Bag Syndrome is observed mainly in elderly constipated women with long term indwelling Foley catheters and urinary tract infections. Constipation increases the conversion of dietary tryptophan to indole, which is detoxified in the liver to indoxyl sulphate, excreted in the urine, and converted to indoxyl during episodes of urinary infection. Alkaline urine promotes the conversion of indoxyl to indigo (blue color) and indirubin (red color), resulting in a purple color (NDT Plus 5:365).
- A new variant of the Munchausen’s syndrome was manifested by repeated bouts of severe hyperkalemia to the point of requiring both dialysis and placement of a defibrillator. It was eventually diagnosed by finding a high citrate concentration in the vomitus. The patient had been ingesting potassium citrate in a fizzy over- the- counter formulation that also contained citric acid, the presence of which may have masked the ensuing alkalosis (NDT Plus 1:23–26).
- In the diagnosis of ethylene glycol intoxication, an approximate blood level may be calculated by multiplying the osmolal gap by 6.2. Also helpful is the appearance of a green-colored glow of the urine under a Wood’s lamp or a fluorescent microscope. Urinary calcium oxalate crystals may be envelope or needle shaped; the latter may be mistaken for hippurate crystals (Kidney Int 73: 1202).
- Edema and hypoalbuminemia in the absence of liver, heart, or kidney disease may be due protein-losing enteropathy. It was diagnosed in a cachectic bedridden man with diffuse muscle atrophy by finding protein loss from the ascending colon on 99mTc-labeled human serum albumin scintigraphy, and confirmed by colonoscopy showing chronic colitis (Kidney Int 75; 1124).
- Microalbuminuria is more reliably detected in a first morning void urine rather than in a random spot urine. According to a study of 241 participants from the Netherlands, a morning albumin/creatinine ratio was an acceptable alternative to measuring 24-hour urinary albumin excretion (J Am Soc Nephrol 20: 436).
- The heavyweight boxing champion Vitali Klitschko has found a new use for voided urine. He wraps his fists with his son’s wet diapers in order to decrease the post-bout swelling, (Physician’s Practice, Jan 2009:21).
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