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Flamarion E, Reichert C, Sayegh C, de Saint Gilles D, Bariseel R, Arnoux JB, Schmitt C, Poli A, Karras A, Pouchot J, Cheminet G, Penet MA. [Abnormal urine color assessment: The urine wheel]. Rev Med Interne 2021; 43:31-38. [PMID: 33736891 DOI: 10.1016/j.revmed.2021.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 02/14/2021] [Indexed: 12/17/2022]
Abstract
Looking at the urine for diagnostic purposes, once performed by ancient Egyptians, can still provide some valuable clues in modern medicine. Several diseases have been named after their associated urine color and this underlines the clinical value of visual urine inspection: blue diaper disease, purple urine bag syndrome, black urine disease or porphyria. Abnormal urine color could be challenging for the clinician: it may reveal neoplastic disease (urologic cancer; melanoma), cell lysis (rhabdomyolysis; hemolysis), infection (lymphatic filariasis; malaria), enzyme deficiency (porphyria; alkaptonuria), medication or food intake. In this article, we present the diagnostic approach, the mechanisms involved and the main causes of abnormal urine color.
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Affiliation(s)
- Edouard Flamarion
- Hôpital Européen Georges Pompidou, Service de médecine interne, APHP-Centre, Université de Paris, France.
| | - Constance Reichert
- Hôpital Européen Georges Pompidou, Service de médecine interne, APHP-Centre, Université de Paris, France
| | - Caroline Sayegh
- Hôpital Européen Georges Pompidou, Service de médecine interne, APHP-Centre, Université de Paris, France
| | - David de Saint Gilles
- Hôpital Européen Georges Pompidou, Service de médecine interne, APHP-Centre, Université de Paris, France
| | - Romane Bariseel
- Hôpital Européen Georges Pompidou, Service de médecine interne, APHP-Centre, Université de Paris, France
| | - Jean Baptise Arnoux
- Hôpital Necker Enfants Malades, Centre de Référence des Maladies Héréditaires du Métabolisme, APHP-Centre, Université de Paris, France
| | - Caroline Schmitt
- Hôpital Louis Mourier, Centre Français des Porphyries, APHP-Nord, Centre de recherche sur l'inflammation, INSERM U1149, Université de Paris, France
| | - Antoine Poli
- Hôpital Louis Mourier, Centre Français des Porphyries, APHP-Nord, Centre de recherche sur l'inflammation, INSERM U1149, Université de Paris, France
| | - Alexandre Karras
- Hôpital Européen Georges Pompidou, Service de néphrologie, APHP-Centre, Université de Paris, France
| | - Jacques Pouchot
- Hôpital Européen Georges Pompidou, Service de médecine interne, APHP-Centre, Université de Paris, France
| | - Geoffrey Cheminet
- Hôpital Européen Georges Pompidou, Service de médecine interne, APHP-Centre, Université de Paris, France
| | - Marie Aude Penet
- Hôpital Européen Georges Pompidou, Service de médecine interne, APHP-Centre, Université de Paris, France
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Vilela M, Fernandes D, Salazar T, Duarte A. Hulk-Like Urine: A Case of Green Urine Caused by Flupirtine Intoxication. Cureus 2020; 12:e12333. [PMID: 33520530 PMCID: PMC7839280 DOI: 10.7759/cureus.12333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2020] [Indexed: 12/01/2022] Open
Abstract
Acute intoxications are common causes of admission to the Emergency Department (ED). Flupirtine is a non-opioid analgesic, originally used for acute and chronic pain. Because of several reports of severe liver toxicity, its use was limited to acute pain in 2013 by the European Medicines Agency. Although withdrawn from the European market in March 2018, there are still flupirtine tablets in many households, and most people are unaware of the hazards they might be facing. A 58-year-old man was admitted to the ED after a suicide attempt with 1 g of flupirtine. He was lethargic and confused but presented no focal neurological deficits or other symptoms, and the rest of his clinical examination was unremarkable. His cerebral CAT and blood chemistry showed no alterations. The only remarkable feature was that he had green urine. After a careful literature search, a similar case was found caused by flupirtine intoxication. After 24 hours of vigilance in the ED, he improved his neurological status and his urine lost part of its greenish color. He was then transferred to the Psychiatric Department, where he presented a complete remission of the clinical alterations. A follow-up check-up showed no permanent deficits.
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Affiliation(s)
- Maria Vilela
- Internal Medicine, Centro Hospitalar do Médio Ave, Vila Nova de Famalicão, PRT
| | - Diana Fernandes
- Internal Medicine, Centro Hospitalar Do Médio Ave, Vila Nova de Famalicão, PRT
| | - Tatiana Salazar
- Internal Medicine, Centro Hospitalar Do Médio Ave, Vila Nova de Famalicão, PRT
| | - Augusto Duarte
- Internal Medicine, Centro Hospitalar do Médio Ave, Vila Nova de Famalicão, PRT
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Hufschmidt A, Krisch A, Peschen I. A girl with headache, confusion and green urine. J Neurol 2009; 256:1169-70. [PMID: 19252777 DOI: 10.1007/s00415-009-5061-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2008] [Revised: 01/15/2009] [Accepted: 01/17/2009] [Indexed: 11/29/2022]
Abstract
The case of a 17-year-old girl with a history of headache, blurred vision, confusion, ataxia and syncope is presented. On admission, she had already recovered except for a slurring of speech. Her urine was found to be green. Screening for illegal drugs was negative, but gas chromatography with subsequent mass spectroscopy (GC-MS) revealed an extremely high concentration of flupirtine.
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