A change in urine color can be distressing for patients and physicians alike. A lot of the causes of abnormal urine color are benign results of medications and foods; nevertheless, a modification in urine color might suggest an underlying pathological condition. Fortunately is that in some cases the diagnosis can be figured out from a thorough history and urinalysis. This post provides a number of the conditions physicians may experience and will help them form a narrow differential medical diagnosis and treatment strategy.
Baby Urine Color Meaning
Abnormal urine color can be upsetting to patients, their family members, and clinicians alike. Patients expect a description for any alterations in the color of their urine, and rightfully so. Unfortunately, tiny bit of original research study exists concerning urine staining. Much of the information comes from case credit reports. More complicating the issue is that there is no objective, standardized way to explain urine color. One author may use the term “dark” to explain findings without totally specifying the term to suggest either a bolder shade of yellow, muddy brown, orange, and even a crimson red.
More than 20 years back, the Southern Medical Journal published an evaluation post on the differential diagnosis of numerous urine colors. Although helpful at that time, clinicians are unlikely to carry out benchtop chemistry tests such as including hypochlorite bleach to urine samples to determine the existence of aminosalicylic acid. The present review efforts to note a lot of the conditions doctors may experience and help them form a slim differential medical diagnosis and treatment plan.
Red Urine in Baby
The first problem we encounter with word “red” is that the term is broad enough to include the colors pink, tones of red, orange, brown, or black, depending upon which clinician views the sample. Whenever a patient establishes red urine, the physician must always order a urine dipstick and urinalysis to search for the presence of red blood cells or hemoglobin. If blood is really present, then the differential is broad and includes conditions of the renal gathering system and hematologic system, and contamination from menstrual blood. Extra workup will be assisted depending on the patient’s history and physical examination. A computed tomography scan might clarify a physiological issue such as entrapment of the left renal vein between the superior mesenteric artery and the aorta, typically referred to as Nutcracker syndrome. A transfusion reaction, glucose-6 -phosphate dehydrogenase shortage, sickle cell anemia, or thalassemia can cause a hemolytic anemia and darken the urine to a deep reddish color.
Even without the existence of blood, dark red urine might be a threatening sign. The classification of illness jointly known as porphyria can provide with dark urine, abdominal pain, photosensitive rashes, or neuropsychiatric complaints. The disease is tough to spot because it is uncommon. In addition, many health center labs are ill equipped to carry out porphyrin analysis on urine, further delaying treatment.
A relatively new advancement in United States toxicology practice is using hydroxocobalamin for cyanide poisoning. The standard treatments for cyanide poisoning– amyl nitrite, salt nitrite, and salt thiosulfate– can induce methemoglobinemia, more minimizing the oxygen-carrying ability of red cell. Hydroxocobalamin works by integrating with cyanide to form cyanocobalamin (vitamin B). An unintentional yet benign effect of its administration is to color the skin and urine red. The effects normally diminish after a few days.
Other medications related to red urine development consist of warfarin, phenazopyridine, rifampin, ibuprofen, and deferoxamine. Certain foods such as carrots (carotene), blackberries, and beets can sometimes cause red urine. Strangely enough, beeturia seems to be connected to the co-ingestion of oxalate-containing foods such as rhubarb, spinach, and oysters.
Lastly, a patient with factitious disorder may present with red urine from including blood or another red-colored material straight to his or her sample. These patients might present with otherwise nonspecific complaints and will go through a substantial however useless workup. Malingering is challenging to identify and may need repeat urine samples obtained under direct observation to finally discover the condition.
Orange Urine Meaning
Continuing along the spectrum of red conditions, orange urine may be a symptom of one of the above-named conditions or ingested drugs such as high-dose riboflavin, phenazopyridine, and isoniazid. According to one research study, 50 % of isoniazid users will discover discoloration, making the finding common however insensitive when checking for compliance. The discovery is safe and needs no further workup if there are no added problems.
Strangely enough, one case file discusses an infant with orange urine triggered by a urinary tract infection. The evident cause was a Gram-negative bacillus that produces indole from tryptophan. The conclusion reached by the authors is peculiar because indole reactions typically produce blue, green, or purple urine.
My Baby Has Brown Urine
As red urine ends up being darker, some clinicians might interpret the color as brown. As a result, any of the conditions or ingestions listed above ought to be thought about whenever a sample is believed to be brown. In the 1980s, a case series on acetaminophen overdose showed that in addition to hepatorenal failure, 3 patients developed brown urine since of the buildup of the metabolite p-aminophenol.
Brown urine could be a sign of melanocytes in the urinary system. Metastatic melanoma can result in an unusual condition called diffuse melanosis, causing dark skin, remote sores to the internal organs, and brown or black urine. One case file mentions a patient with intense kidney injury from melanin build-up in the tubular system. The diagnosis is poor at this moment.
Black Urine
Black urine rounds out the conversation of causes of reddish urine discoloration. A number of the conditions noted above can provide with black urine if the discoloration is dark enough; nevertheless, several of the conditions noted below are unsafe enough that the presence of black urine needs added workup. Example causes include metronidazole, nitrofurantoin, cascara or senna laxatives, methocarbamol, sorbitol, and the phenol acquired cresol, a common disinfectant ingested by alcoholics, which often is incapacitating and leads to severe systemic toxicity. Intramuscular iron injections are also associated with black urine as a benign effect of the medication.
Patients in this case merely need reassurance. The existence of melanin in the urine can cause brown discoloration, as talked about above, or with a black tint.
- Methyldopa and L-dopa can induce urinary melanin in alkalotic urine, which is a recognized adverse result of these medications. Alcaptonuria is a rare hereditary illness in which the body has actually a weakened capability to catabolize tyrosine, leading to a build-up of homogentisic acid in the body. It provides clinically with arthritis and darkening of the skin and urine. The medical diagnosis is made by determining homogentisic acid in the urine. There is no remedy, however, and treatment includes high-dose vitamin C and limiting protein intake.
Blue and Green Colored Urine
Blue urine most typically appears to be caused by intake of methylene blue. This drug is utilized in the United States for diagnostic tests, treatment of methemoglobinemia, or as a treatment for refractory hypotension. Outside the nation, nevertheless, oral methylene blue might be found in medications and home treatments due to the fact that it has antimicrobial homes. Real blue urine seems to be extremely unusual, perhaps due to the fact that blue pigments integrate with urochrome, the major factor to urine’s typical yellow shade, to create a green color before urine’s removal. In that regard, there are many case reports in which methylene blue turns urine green.
Other medications associated with green urine may consist of phenol groups and include promethazine, thymol, cimetidine, and propofol. The system of action appears to be triggered by phenol’s conjugation by the liver and subsequent excretion by the kidneys. The stamina of the green appears to be dose related. Oddly, propofol likewise is related to pink and white urine.
Some nonphenol drugs noted to produce green urine are metoclopramide, amitriptyline, and indomethacin. In any occasion, the urinary findings of all of the above medications are benign effects and do not obtain even more workup once urinalysis outcomes are typical.
There are isolated case reports of parenteral absorption of tetrahydronaphthalene (Cuprex), a pesticide that was made use of in the 1980s as an over the counter treatment for lice, and intakes of the herbicides mefenaceta and imazosulfuro producing green urine. A patient who has can be found in contact with these compounds need to be dealt with as if he or she were poisoned and is worthy of complete toxicology workup, stabilization, and possible admission to the intensive care system.
In the vital care setting, patients getting enteral tube feeds carry occasion been noted to produce green urine. The belief is that the food coloring additive Food Dye and Color Blue Number 1 (FD&C Blue No. 1) is taken in from the gastrointestinal (GI) system in high adequate concentrations to trigger dark green urine. In animal models, > 1 % of FD&C Blue No. 1 is discovered in rat urine. This finding is safe and disappears with changes in tube feeds.
Not all causes of green urine are innocuous, nevertheless. Pseudomonas-causing bacteremia and urinary system infections can provide with green urine. In this case, the patient’s history and health examination need to indicate an infectious condition and urine and blood cultures may make the medical diagnosis. Treatment is centered on clearing the infection instead of on urine color.
Bile pigments in the urine represent an uncommon however worrisome reason for discoloration. Upon finding biliverdin, clinicians have to take a mindful and thorough history to identify the place of the leak. Radiographs or intrusive imaging might even be required. A case credit report of an enterovesical fistula triggered by pelvic radiation therapy offers one such source of bile. Other rarer causes of blue and green urine consist of conditions that impair amino acid absorption from the GI system.
Blue diaper syndrome and Hartnup illness are autosomal recessive conditions in which tryptophan develops in the GI system, triggering bacteria to metabolize it to indole, causing an accumulation of indican in the urine. The blue coloring by itself is not harmful, however it does indicate another underlying condition that requires examination.
Purple Urine
The just recognized reason for purple urine is purple urine bag syndrome. This normally benign condition is thought to arise from a series of steps in which tryptophan in the GI system is converted to indole, the indole is then metabolized by the liver and excreted by the kidneys, and the end product goes through change by bacteria in the urine to develop indigo (a blue pigment) and indirubin (a red pigment). These pigments combine to form purple urine that then stains the polyvinylchloride of a Foley catheter. Purple urine is connected with Gram-negative bacteruria and typically resolves after treatment with antibiotics and altering the catheter.
White Urine (Albinuria) in Babies
Albinuria has a large differential medical diagnosis and requires a more extensive investigation beyond an easy urinalysis. Sediment from minerals in the urine such as hypercalciuria, phosphaturia, or hyperoxaluria occasionally can be discovered after centrifugation and analysis. Assessment with a nephrologist is recommended now because modifications in dietary consumption and medication initiation might be needed. Severe urinary system infection is one possible reason for white urine because purulent fluid might enter the bladder. In addition, caseous product from urinary tuberculosis typically should be amused. Careful urine culture is needed, followed by antibiotic therapy.
Chyluria is another possible medical diagnosis. It develops from irregular communication between the lymphatics to the urinary tract, most frequently as an outcome of filariasis, but typically can be the result of a lymphatic fistula. Antiparasitic drugs are of no advantage since the urine is typically sterile by this point. Referral to a urologist is necessary since the patient may need intervention to close the communication.
Conclusions
A changing in urine color can be traumatic for patients, their relative, and clinicians alike. This short article presented a number of the possible reasons for urine staining in children. Fortunately, a lot of these causes are benign impacts and can be clarified from an in-depth history. At a minimum, nevertheless, doctors must take a urinalysis when confronted with an unusual urine color since possible pathologies do exist.