Pink urine in an elderly woman

Tan, Che-Kim; Lai, Chih‐Cheng

doi:10.1111/j.1447-0594.2011.00760.x

Cited by 3 publications

(5 citation statements)

References 8 publications

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“…UA crystals are normally colorless, but can turn pink if they absorb pink urine pigments. [ 8 ] Several factors are known to contribute to UA crystallization. Urine pH has a major influence on the probability of UA precipitation by shifting UA to a protonated, neutral, non-water-soluble form, the origin of crystals.…”

Section: Discussionmentioning

confidence: 99%

Pink urine syndrome in an anuric patient during continuous renal replacement therapy: A case report

Julien,

Saint Gilles,

Allou

2024

Medicine

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Introduction: Pink urine syndrome is a rare, poorly understood condition, often prompted by obesity, insulin resistance, and the drug propofol. It is characterized by pink urine or urine sediment and occurs in the absence of a heme or food-based pigment. The pathophysiology of this syndrome is not yet fully understood but is linked to a uric acid metabolism disorder. Pink urine syndrome is less familiar to anesthesiologists than other propofol infusion complications. Our case report aims to highlight this rarely encountered syndrome, whose both diagnosis and therapeutic may be challenging. We have reported the first case of this syndrome evidenced by the change in color of the effluent bag during continuous veno-venous hemofiltration (CVVHF). Case presentation: A 61-year-old woman was admitted to the intensive care unit following a recovered cardiorespiratory arrest due to ventricular arrhythmia. She was placed in hypothermia, sedated with propofol (300 mg/h), and started on CVVHF for oligo-anuric acute kidney injury associated with severe metabolic acidosis. A few hours after initiation of CVVHF, the effluent bag turned bright pink. Given the pink color of the effluent bag and the hypothesis of propofol-induced pink urine syndrome, propofol was replaced by midazolam. After stopping propofol, the color of effluent bag lightened. Unfortunately, the patient died on the third day of hospitalization due to diffuse cerebral edema. Conclusions: We report here the first case of pink urine syndrome as revealed by the change in color of the contents of the CVVHF effluent bag in an anuric patient. This syndrome is rare but significant in anesthesia/intensive care settings, where propofol is a frequently used sedative. Knowledge of this syndrome appears to be important to avoid irrelevant additional investigations and to optimize the therapeutic strategy.

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Section: Discussionmentioning

confidence: 99%

Pink urine syndrome in an anuric patient during continuous renal replacement therapy: A case report

Julien,

Saint Gilles,

Allou

2024

Medicine

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“…PUS is a rare condition with uric acid metabolism disorders characterized by strawberry-red urine and the formation of massive pink sediment ( Potton et al, 2013 ). Pure UA dihydrate crystals are amorphous and colorless but can become pink upon absorbing pink urinary pigments ( Tan and Lai, 2012 ). PUS has been most frequently observed in patients with morbid obesity and/or insulin resistance, which may potentially involve UA metabolic disorders ( Deitel et al, 1984 ; Tucker and Perazella, 2019 ).…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Other risk factors, including V1 receptor activation, low urinary pH and high urine osmolarity, have been implicated in PUS ( Tan and Lai, 2012 ; Tucker and Perazella, 2019 ). Stress-related antidiuretic hormone release, via its V1 receptor, favors renal UA clearance and causes UA crystalluria ( Tan and Lai, 2012 ). A low urinary pH attributed to intraoperative potential respiratory acidosis and high urine osmolarity associated with dehydration may also be involved in PUS ( Tucker and Perazella, 2019 ).…”

Section: Discussionmentioning

confidence: 99%

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Case Report: Pink Urine Syndrome Following Exposure to Propofol: A Rare, Impressive but Benign Complication

et al. 2021

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Drug-induced changes in urine color induced by drugs may have clinical significance. Pink urine syndrome (PUS), which has been associated with urinary uric acid (UA) disorders, is most frequently reported in patients with morbid obesity undergoing gastric bypass surgery and/or from propofol anesthesia use in those who potentially have preexisting UA metabolism disorders. However, PUS has rarely occurred following exposure to propofol in non-obese patients, and literature on long-term follow-up after PUS is scarce. We report a case of PUS induced by propofol in a previously healthy non-obese woman after undergoing thoracoscopic wedge resection of pulmonary nodules under general anesthesia using propofol. The patient suddenly developed pink urine 4 h after surgery. A pink sediment rapidly precipitated at the bottom of the test tube following centrifugation of the urine. Amorphous, colorless UA-like crystals were identified under a polarizing microscope. The diagnosis of PUS was confirmed by examining the urinary UA concentration. The patient recovered and as followed-up for 1 month, during which she did not experience any urinary complications. To our knowledge, this is the first report to describe in detail a case of PUS caused by propofol in a non-obese patient with follow-up. PUS is usually benign and can resolve by rapidly on administering lactated Ringer’s solution; however, the potential risk of urinary complications, particularly UA lithiasis, should be fully realized.

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“…2016 Taiwan [98]69 - Male–5.5–YesNo AKIOpen fracture of the right femoral shaftVerhoeven E, et al . 2014 Belgium [99]55 - Male–5–Yes–Alcohol abuse with valerian extract overdoseKato N and Ogawa R. 1999 Japan [100]32 - Male––7YesNo AKIAdmitted for ulnar nerve injury; alcoholic, hypercholesterolemiaTan CK and Lai CC 2012 Taiwan [101]67 - Female275.53.6No–Admitted with spontaneous bacterial peritonitis and hepatic encephalopathy from upper gastrointestinal bleeding; overweight, diabetes mellitus, liver cirrhosisSinnollareddy M, et al . 2014 Australia [102]29 - Male–––Yes–Respiratory distress syndrome with acute alcohol toxicity61 - Male95kg (no height given)Yes–AKI, acute kidney injury; CHF, congestive heart failure; HTN, hypertension; IVF, i.v.…”

Section: Case Presentationmentioning

confidence: 99%

Pink Urine Syndrome: A Combination of Insulin Resistance and Propofol

Tucker

Perazella

2019

Kidney International Reports

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Pink urine syndrome is mostly seen in patients treated with propofol anesthesia. The pink color is attributed to the presence of large concentrations of uric acid (and pigment), which is excreted in large amounts when propofol is given. We describe a case of propofol-induced pink urine syndrome and perform a comprehensive, evidence-based review. We discuss prior case studies already published in the literature as we speculate on the pathophysiology and how it translates to a clinically relevant entity.

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Pink urine in an elderly woman

Cited by 3 publications

References 8 publications

Pink urine syndrome in an anuric patient during continuous renal replacement therapy: A case report

Pink urine syndrome in an anuric patient during continuous renal replacement therapy: A case report

Case Report: Pink Urine Syndrome Following Exposure to Propofol: A Rare, Impressive but Benign Complication

Pink Urine Syndrome: A Combination of Insulin Resistance and Propofol

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