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Kung WM, Lin HHH, Wang YH, Lin AYC. Solar-driven persulfate degradation of caffeine and cephradine in synthetic human urine. JOURNAL OF HAZARDOUS MATERIALS 2024; 465:133031. [PMID: 38008053 DOI: 10.1016/j.jhazmat.2023.133031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/08/2023] [Accepted: 11/16/2023] [Indexed: 11/28/2023]
Abstract
Urine source separation, as an innovative concept for the reuse of microlevel nutrients in human urine, has drawn increasing attention recently. Consequently, removing coexisting pharmaceuticals in urine is necessary for further reuse. This study is the first to apply the solar-driven persulfate process (Solar/PS) to the investigation of cephradine (CFD) and caffeine (CAF) degradation in synthetic human urine. The results showed that significantly more degradation of CFD and CAF occurs with the Solar/PS process than with persulfate oxidation and direct sunlight photolysis, respectively. The generated reactive species ·OH, SO4·-, O2·- and 1O2 were identified in the Solar/PS process. While SO4·- played a dominant role at pH 6, it played a minor role at pH 9 due to the lower amount generated under alkaline conditions. The presence of chloride and ammonia negatively impacted the photodegradation of both compounds. In contrast, bicarbonate exhibited no effect on CAF but enhanced CFD degradation owing to its amino-acid-like structure, which has a higher reactivity toward CO3·-. Although total organic carbon (TOC) was partially mineralized after 6 h of operation, no Microtox® toxicity was observed.
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Affiliation(s)
- Wei-Ming Kung
- Graduate Institute of Environmental Engineering, National Taiwan University, 71, Chou-Shan Rd., Taipei 106, Taiwan, ROC
| | - Hank Hui-Hsiang Lin
- Graduate Institute of Environmental Engineering, National Taiwan University, 71, Chou-Shan Rd., Taipei 106, Taiwan, ROC
| | - Yu-Hsiang Wang
- Graduate Institute of Environmental Engineering, National Taiwan University, 71, Chou-Shan Rd., Taipei 106, Taiwan, ROC
| | - Angela Yu-Chen Lin
- Graduate Institute of Environmental Engineering, National Taiwan University, 71, Chou-Shan Rd., Taipei 106, Taiwan, ROC.
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Jiwan NC, Appell CR, Keefe MS, Dunn RA, Luk HY, Sekiguchi Y. Storing urine samples with moisture preserves urine hydration marker stability up to 21 days. Int Urol Nephrol 2023; 55:1413-1419. [PMID: 37016197 DOI: 10.1007/s11255-023-03581-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 03/25/2023] [Indexed: 04/06/2023]
Abstract
INTRODUCTION To assess hydration status, hydration markers [urine color, osmolality, and urine-specific gravity (USG)] are used. Urine color, osmolality, and USG have shown to be stable for 7, 7, and 3 days, respectively, at 4 °C. However, refrigeration could produce a dry environment which enhances evaporation and potentially affects urine hydration markers. PURPOSE To examine the effect of duration and moisture on urine markers with refrigeration. METHODS 24 participants provided urine samples between 9 and 10 AM. Urine color, osmolality, and USG were analyzed within 2 h (baseline). Then, each urine sample was divided into two urine cups and placed in a storage container with (moisture condition) and without (no moisture condition) water bath at 3 °C. Hydration markers were analyzed at day 1(D1), D2, D7, D10, D14, and D21. A two-way ANOVA (time x condition) and repeated-measures ANOVA on time were performed to examine differences. RESULTS No significant (p > 0.05) condition x time effect was observed for urine color (p = 0.363), urine osmolality (p = 0.358), and USG (p = 0.248). When urine samples were stored in moisture condition, urine color (p = 0.126) and osmolality (p = 0.053) were stable until D21, while USG was stable until D2 (p = 0.394). CONCLUSION When assessing hydration status, it appears that the urine color and osmolality were stable for 21 days, while USG was stable for 2 days when stored with moisture at 3 °C. Our results provide guidelines for practitioners regarding urine storage duration and conditions when urine cannot be analyzed immediately.
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Affiliation(s)
- Nigel C Jiwan
- Applied Physiology Laboratory, Department of Kinesiology and Sport Management, Texas Tech University, 3204 Main St., Lubbock, TX, 79409, USA.
| | - Casey R Appell
- Applied Physiology Laboratory, Department of Kinesiology and Sport Management, Texas Tech University, 3204 Main St., Lubbock, TX, 79409, USA
| | - Marcos S Keefe
- Sports Performance Laboratory, Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, TX, USA
| | - Ryan A Dunn
- Sports Performance Laboratory, Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, TX, USA
| | - Hui-Ying Luk
- Applied Physiology Laboratory, Department of Kinesiology and Sport Management, Texas Tech University, 3204 Main St., Lubbock, TX, 79409, USA
| | - Yasuki Sekiguchi
- Sports Performance Laboratory, Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, TX, USA
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Belasco R, Edwards T, Munoz AJ, Rayo V, Buono MJ. The Effect of Hydration on Urine Color Objectively Evaluated in CIE L *a *b * Color Space. Front Nutr 2020; 7:576974. [PMID: 33195369 PMCID: PMC7649145 DOI: 10.3389/fnut.2020.576974] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/15/2020] [Indexed: 11/26/2022] Open
Abstract
Urine color has been shown to be a viable marker of hydration status in healthy adults. Traditionally, urine color has been measured using a subjective color scale. In recent years, tristimulus colorimetry developed by the International Commission on Illumination (CIE L*a*b*) has been widely adopted as the reference method for color analysis. In the L*a*b* color space, L* indicates lightness ranging from 100 (white) to 0 (black), while a* and b* indicate chromaticity. a* and b* are color directions: –a* is the green axis, +a* is the red axis, –b* is the blue axis, and +b* is the yellow axis. The L*a*b* color space model is only accurately represented in three-dimensional space. Considering the above, the purpose of the current study was to evaluate urine color during different hydration states, with the results expressed in CIE L*a*b* color space. The study included 28 healthy participants (22 males and 6 females) ranging between the age of 20 and 67 years (28.6 ± 11.3 years). One hundred and fifty-one urine samples were collected from the subjects in various stages of hydration, including morning samples after 7–15 h of water deprivation. Osmolality and CIE L*a*b* parameters were measured in each sample. As the urine osmolality increased, a significant linear increase in b* values was observed as the samples became more pronouncedly yellow (τb = 0.708). An increase in dehydration resulted in darker and significantly more yellow urine, as L* values decreased in lightness and b* values increased along the blue–yellow axis. However, as dehydration increased, a notable polynomial trend in color along the green–red axis was observed as a* values initially decreased, indicating a green hue in slightly dehydrated urine, and then increased as urine became more concentrated and thus more dehydrated. It was determined that 74% of the variance seen in urine osmolality was due to CIE L*a*b* variables. This newfound knowledge about urine color change along with the presented regression model for predicting urine osmolality provides a more detailed and objective perspective on the effect of hydration on urine color, which to our knowledge has not been previously researched.
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Affiliation(s)
- Rebekah Belasco
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, United States
| | - Tory Edwards
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, United States
| | - A J Munoz
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, United States
| | - Vernon Rayo
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, United States
| | - Michael J Buono
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, United States
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Megahed AA, Grünberg W, Constable PD. Clinical utility of urine specific gravity, electrical conductivity, and color as on-farm methods for evaluating urine concentration in dairy cattle. J Vet Intern Med 2019; 33:1530-1539. [PMID: 31025445 PMCID: PMC6524117 DOI: 10.1111/jvim.15502] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 04/03/2019] [Indexed: 11/26/2022] Open
Abstract
Background Urine concentration (UC) provides clinically useful information concerning hydration status and renal function of animals. Objectives To characterize the clinical performance of urine specific gravity measured by optical refractometry (USG‐R) or Multistix‐SG urine reagent dipstick (USG‐D), urine electrical conductivity using an OAKTON Con 6 conductivity handheld meter (UEC), urine color (UColor) using a custom‐designed 8‐point color chart, and urine creatinine concentration (UCreat) for assessing UC in dairy cattle. Animals 20 periparturient Holstein‐Friesian cows. Methods Urine was obtained by perineal stimulation or urethral catheterization and urine osmolality (UOsm, reference method), USG‐R, USG‐D, UEC, UColor, and UCreat determined. Diagnostic test performance was evaluated using Spearman's rho and logistic regression to determine the area under the receiver operating curve (AUC) and optimal cut point for diagnosing hypohydration (UOsm ≥800 mOsm/kg). P < .05 was considered significant. Results The best performing test for diagnosing hypohydration was USG‐R (AUC = 0.90) at an optimal cut point ≥1.030. The second‐best performing test was UEC (AUC = 0.82) at a cut point of ≥23.7 mS/cm, followed by UCreat (AUC = 0.76) at a cut point of ≥95.3 mg/dL, and UColor (AUC = 0.74) at a cut point of ≥4 on an 8‐point scale. Urine specific gravity measured by dipstick performed poorly (AUC = 0.63). Conclusions and Clinical Importance USG‐R and UEC provide practical and sufficiently accurate methods for measuring UC in dairy cattle. Urine color had moderate clinical utility as a no‐cost cow‐side method for assessing UC, whereas dipstick refractometry is not recommended for assessing UC.
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Affiliation(s)
- Ameer A Megahed
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois at Urbana-Champaign, Champaign, Illinois.,Department of Animal Medicine, Internal Medicine, Faculty of Veterinary Medicine, Benha University, Benha, Egypt
| | - Walter Grünberg
- Clinic for Cattle, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
| | - Peter D Constable
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois at Urbana-Champaign, Champaign, Illinois
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Metabolic Profiles of Propofol and Fospropofol: Clinical and Forensic Interpretative Aspects. BIOMED RESEARCH INTERNATIONAL 2018; 2018:6852857. [PMID: 29992157 PMCID: PMC5994321 DOI: 10.1155/2018/6852857] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 03/27/2018] [Accepted: 04/15/2018] [Indexed: 02/08/2023]
Abstract
Propofol is an intravenous short-acting anesthetic widely used to induce and maintain general anesthesia and to provide procedural sedation. The potential for propofol dependency and abuse has been recognized, and several cases of accidental overdose and suicide have emerged, mostly among the health professionals. Different studies have demonstrated an unpredictable interindividual variability of propofol pharmacokinetics and pharmacodynamics with forensic and clinical adverse relevant outcomes (e.g., pronounced respiratory and cardiac depression), namely, due to polymorphisms in the UDP-glucuronosyltransferase and cytochrome P450 isoforms and drugs administered concurrently. In this work the pharmacokinetics of propofol and fospropofol with particular focus on metabolic pathways is fully reviewed. It is concluded that knowing the metabolism of propofol may lead to the development of new clues to help further toxicological and clinical interpretations and to reduce serious adverse reactions such as respiratory failure, metabolic acidosis, rhabdomyolysis, cardiac bradyarrhythmias, hypotension and myocardial failure, anaphylaxis, hypertriglyceridemia, renal failure, hepatomegaly, hepatic steatosis, acute pancreatitis, abuse, and death. Particularly, further studies aiming to characterize polymorphic enzymes involved in the metabolic pathway, the development of additional routine forensic toxicological analysis, and the relatively new field of ‘‘omics” technology, namely, metabolomics, can offer more in explaining the unpredictable interindividual variability.
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Marvin S, Gustafson S, Thibeault S. Detecting Aspiration and Penetration Using FEES With and Without Food Dye. Dysphagia 2016; 31:498-504. [DOI: 10.1007/s00455-016-9703-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 03/07/2016] [Indexed: 10/22/2022]
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Kavouras SA, Johnson EC, Bougatsas D, Arnaoutis G, Panagiotakos DB, Perrier E, Klein A. Validation of a urine color scale for assessment of urine osmolality in healthy children. Eur J Nutr 2015; 55:907-15. [PMID: 25905541 PMCID: PMC4819932 DOI: 10.1007/s00394-015-0905-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 04/09/2015] [Indexed: 11/25/2022]
Abstract
AIM Urine color (UC) is a practical tool for hydration assessment. The technique has been validated in adults, but has not been tested in children. PURPOSE The purpose of the study was to test the validity of the urine color scale in young, healthy boys and girls, as a marker of urine concentration, investigate its diagnostic ability of detecting hypohydration and examine the ability of children to self-assess UC. METHODS A total of 210 children participated (age: 8-14 years, body mass: 43.4 ± 12.6 kg, height: 1.49 ± 0.13 m, body fat: 25.2 ± 7.8 %). Data collection included: two single urine samples (first morning and before lunch) and 24-h sampling. Hydration status was assessed via urine osmolality (UOsmo) and UC via the eight-point color scale. RESULTS Mean UC was 3 ± 1 and UOsmo 686 ± 223 mmol kg(-1). UC displayed a positive relationship as a predictor of UOsmo (R (2): 0.45, P < 0.001). Based on the receiver operating curve, UC has good overall classification ability for the three samples (area under the curve 85-92 %), with good sensitivity (92-98 %) and specificity (55-68 %) for detecting hypohydration. The overall accuracy of the self-assessment of UC in the morning or the noon samples ranged from 67 to 78 %. Further threshold analysis indicated that the optimal self-assessed UC threshold for hypohydration was ≥4. CONCLUSIONS The classical eight-point urine color scale is a valid method to assess hydration in children of age 8-14 years, either by researchers or self-assessment.
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Affiliation(s)
- Stavros A Kavouras
- Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville, AR, 72701, USA.
| | - Evan C Johnson
- Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville, AR, 72701, USA
| | - Dimitris Bougatsas
- Department of Dietetics and Nutrition, Harokopio University, Athens, Greece
| | - Giannis Arnaoutis
- Department of Dietetics and Nutrition, Harokopio University, Athens, Greece
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Regensburger M, Huttner HB, Doerfler A, Schwab S, Staykov D. Propofol-related urine discoloration in a patient with fatal atypical intracerebral hemorrhage treated with hypothermia. SPRINGERPLUS 2014; 3:551. [PMID: 25332856 PMCID: PMC4192142 DOI: 10.1186/2193-1801-3-551] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 09/16/2014] [Indexed: 11/10/2022]
Abstract
Introduction Mild therapeutic hypothermia is an increasingly recognised treatment option to reduce perihemorrhagic edema in severe intracerebral hemorrhage. Case description We report the case of a 77-year old woman with atypical intracerebral hemorrhage that was treated with mild hypothermia in addition to osmotic therapy. The patient’s urine subsequently showed a green discoloration. Urine discoloration was completely reversible upon discontinuation of propofol. Discussion and evaluation Propofol-related urine discoloration may have been provoked by hypothermia. Due to the benign nature of this side effect, propofol should be stopped and gastrointestinal function should be supported. Conclusion More studies are needed to show a causal role of hypothermia and related decreased enzymatic function.
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Affiliation(s)
- Martin Regensburger
- Department of Neurology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany ; Division of Molecular Neurology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Hagen B Huttner
- Department of Neurology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Arnd Doerfler
- Department of Neuroradiology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Stefan Schwab
- Department of Neurology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Dimitre Staykov
- Department of Neurology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany
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Viswanathan S. Urine bag as a modern day matula. ISRN NEPHROLOGY 2013; 2013:215690. [PMID: 24959539 PMCID: PMC4045424 DOI: 10.5402/2013/215690] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 05/08/2013] [Indexed: 11/23/2022]
Abstract
Since time immemorial uroscopic analysis has been a staple of diagnostic medicine. It received prominence during the middle ages with the introduction of the matula. Urinary discoloration is generally due to changes in urochrome concentration associated with the presence of other endogenous or exogenous pigments. Observation of urine colors has received less attention due to the advances made in urinalysis. A gamut of urine colors can be seen in urine bags of hospitalized patients that may give clue to presence of infections, medications, poisons, and hemolysis. Although worrisome to the patient, urine discoloration is mostly benign and resolves with removal of the offending agent. Twelve urine bags with discolored urine (and their predisposing causes) have been shown as examples. Urine colors (blue-green, yellow, orange, pink, red, brown, black, white, and purple) and their etiologies have been reviewed following a literature search in these databases: Pubmed, EBSCO, Science Direct, Proquest, Google Scholar, Springer, and Ovid.
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Affiliation(s)
- Stalin Viswanathan
- Department of General Medicine, Indira Gandhi Medical College, Kathirkamam, Pondicherry 605009, India
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Abstract
We present a case of green urine caused by ingestion of the cyclic antidepressant amitryptilline and a brief review of the causes for green urine or verdoglobinuria. The possible etiologies for green urine are diverse, however, pharmaceuticals are the most common etiologic agents. While the frequency of occurrence of green urine remains unknown, an awareness of the potential etiologies is essential for the clinical toxicologist to develop a useful differential diagnosis for the problem.
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Affiliation(s)
- Michael Greenberg
- Emergency Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania 19102, USA.
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Abstract
The development of discolored urine may have many possible causes. Here we present the case of a 76-year-old woman who was admitted after ingesting the inorganic herbicides, mefenacet and imazosulfuron. Her urine color changed to green almost immediately. Since the patient had no specific medication or medical history we considered that the most likely cause of the change in urine color was the ingestion of the herbicides. Spectrophotometric analysis of the urine was conducted and a peak was observed in the green area of the wavelength spectrum. These findings show that mefenacet and imazosulfuron should be considered in the differential diagnosis of green discolored urine.
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Affiliation(s)
- Yun-Suk Shim
- Division of Nephrology, Department of Internal Medicine, SoonChunHyang University Cheonan Hospital, Cheonan, Korea
| | - Hyo-Wook Gil
- Division of Nephrology, Department of Internal Medicine, SoonChunHyang University Cheonan Hospital, Cheonan, Korea
| | - Jong-Oh Yang
- Division of Nephrology, Department of Internal Medicine, SoonChunHyang University Cheonan Hospital, Cheonan, Korea
| | - Eun-Young Lee
- Division of Nephrology, Department of Internal Medicine, SoonChunHyang University Cheonan Hospital, Cheonan, Korea
| | - Soo-Hyun Kim
- Proteome Analysis Team, Korea Basic Science Institute, Daejeon, Korea
| | - Sae-Yong Hong
- Division of Nephrology, Department of Internal Medicine, SoonChunHyang University Cheonan Hospital, Cheonan, Korea
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Use of Colored Dyes in Enteral Formulas. TOP CLIN NUTR 2006. [DOI: 10.1097/00008486-200607000-00009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Brady S. Use of Blue Dye and Glucose Oxidase Reagent Strips for Detection of Pulmonary Aspiration: Efficacy & Safety Update. ACTA ACUST UNITED AC 2005. [DOI: 10.1044/sasd14.4.8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Susan Brady
- Marianjoy Rehabilitation Hospital Wheaton, IL
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Lucarelli MR, Shirk MB, Julian MW, Crouser ED. Toxicity of Food Drug and Cosmetic Blue No. 1 dye in critically ill patients. Chest 2004; 125:793-5. [PMID: 14769768 DOI: 10.1378/chest.125.2.793] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Food Drug and Cosmetic Blue No. 1 dye (FD&C Blue No. 1) is commonly added to enteral nutrition formulations in order to facilitate the detection of gastric aspirate in tracheal secretions of critically ill patients. However, reports of systemic blue dye absorption and associated adverse outcomes are emerging. We report two cases of abnormal systemic absorption of FD&C Blue No. 1 in critically ill patients who subsequently died of refractory shock and metabolic acidosis. Risk factors and mechanisms of FD&C Blue No. 1 toxicity are discussed, and alternate approaches to gastric aspiration detection in critically ill patients are considered.
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Affiliation(s)
- Maria R Lucarelli
- Division of Pulmonary and Critical Care Medicine, Department of Pharmacy, The Dorothy M. Davis Heart & Lung Research Institute, The Ohio State University Medical Center, 473 West Twelfth Avenue, Columbus, OH 43210-1252, USA
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Maloney JP, Ryan TA. Detection of aspiration in enterally fed patients: a requiem for bedside monitors of aspiration. JPEN J Parenter Enteral Nutr 2002; 26:S34-41; discussion S41-2. [PMID: 12405621 DOI: 10.1177/014860710202600606] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Pulmonary aspiration of gastric and oropharyngeal contents is common in enterally fed patients. Detection of early aspiration in these patients has relied on clinical impression, the coloring of enteral feedings with dyes, and less commonly the detection of elevated glucose in tracheal aspirates. The potential benefits, risks, and clinical use of bedside monitors of aspiration are under increasing scrutiny. METHODS Literature review. Although this review reflects the opinions of the authors, recommendations of an expert consensus panel (North American Summit on Aspiration, which included one author, J. P. Maloney) were also used to guide recommendations. The specific recommendations of that panel are presented elsewhere. RESULTS No large prospective clinical trials have been done to evaluate the use and safety of bedside monitors for aspiration. Clinical impression remains a poor "gold standard" of aspiration diagnosis in enterally fed patients. The coloring of enteral feedings with blue dyes (chiefly FD&C Blue No.1) is ubiquitous in hospitals despite evidence that it is not sensitive and potentially harmful. Cases of absorption of blue dye from enteral feedings in patients with critical illness have raised concern about the safety of the blue dye method, particularly in light of apparent toxic effects of these dyes on mitochondria. The glucose detection method has not been embraced; it too has little use and is labor intensive. CONCLUSIONS Use of colored dyes in enteral feedings and glucose detection methods should be abandoned. Nonrecumbent positioning is an evidenced-based method for aspiration prevention that needs to be re-emphasized. Novel bedside methods of detecting early aspiration are needed to supplement preventative strategies.
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Affiliation(s)
- James P Maloney
- Division of Pulmonary and Critical Medicine and Cardiovascular Research Center, Medical College of Wisconsin, Milwaukee 53226, USA.
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Abstract
The development of discolored urine in the critically ill patient, although uncommon, may have many possible causes, with the most likely source related to medication administration. Studies were undertaken in a 39-year-old man who developed dark green urine while in the intensive care unit for neutropenic sepsis. Although the patient had developed prior nonoliguric renal failure stemming from his sepsis, his renal function at the time of presentation of urine discoloration was considered normal. Review of his medications and intravenous infusions suggested the most likely cause was the food dye placed in his enteral tube feedings. Spectrophotometric evaluation of the urine confirmed the presence of Food Dye and Color Blue Number 1 (FD&C Blue No. 1). This case shows that significant gastrointestinal absorption of FD&C Blue No. 1 can occur. FD&C Blue No. 1 should be considered in the differential diagnosis of dark green discolored urine.
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Affiliation(s)
- Gerardo Carpenito
- Division of Nephrology, UCLA School of Medicine, Los Angeles, CA 90095-1689, USA
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