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Green urine in a critically ill patient
1Division of Nephrology, UCLA School of Medicine, Los Angeles, CA 90095-1689, USA.
Summary
Critically ill patients may develop dark green urine due to Food Dye and Color Blue Number 1 (FD&C Blue No. 1) in enteral feedings. This common food dye can be absorbed, causing urine discoloration, and should be considered in diagnoses.
Area of Science:
- Clinical Medicine
- Toxicology
- Gastroenterology
Background:
- Discolored urine in critically ill patients is uncommon but can stem from various causes, often medication-related.
- Neutropenic sepsis is a serious condition requiring intensive care, potentially leading to complications like altered urine appearance.
Observation:
- A 39-year-old male in the ICU for neutropenic sepsis developed dark green urine.
- Despite prior nonoliguric renal failure, his renal function was normal at the time of urine discoloration.
Findings:
- Review of medications and infusions identified FD&C Blue No. 1 in enteral tube feedings as the probable cause.
- Spectrophotometric analysis confirmed the presence of FD&C Blue No. 1 in the patient's urine.
- Significant gastrointestinal absorption of FD&C Blue No. 1 was demonstrated in this case.
Implications:
- FD&C Blue No. 1 should be included in the differential diagnosis for dark green discolored urine in critically ill patients.
- Clinicians should consider enteral feeding additives as a potential source of urine discoloration.
- This case highlights the importance of thorough medication and intake reviews in managing complex patient conditions.