A healthy young girl with a pink specimen and a male teen whose urine is green. What's in your differential Dxs?
Polly has always been healthy; no urinary tract infections/disease in the past; no renal disease in either Polly or the family; no trauma, no menarche.
No new or unusual foods
introduced recently; Polly has not been given any medications in the last year or so.
Likely diagnosis was urate-induced pink coloration
of the urine. More detailed history found that Polly's diet was very rich in purines-sardines, roasted nuts, fried foods.
Red urine can be caused by numerous substances
including anthocyanin, azo dyes, beets, chloroquine, rifampin, rhodamie B, sulfasalazine, urates.
A 16-year-old male presents with green urine.
He was asymptomatic and otherwise entirely well; no history of gall bladder disease.
Green urine and green tongue
appear to be caused by ingestion of Clorets gum for the past several days.
FD&C blue #1
is the culprit ingredient.
Differential diagnosis of green urine:
Iodochlorhydroxyquin-induced, myelo-optic neuropathy, Pseudomonas bacteremia, bile pigment, amitriptyline HCl, methocarbamol, metoclopramide (not an exhaustive list).
Over my years in working with residents, I have always impressed on them that we are all very much medical detectives. It is nice to use dermatology clues, but they are not always present.So, I always emphasize the holistic approach â we must look at urine and stool specimens, blood smears,Â microbiology platesâ¦ whatever we might have to Â assist us as we try to solve “mystery cases.”In recent times, however, performing our own lab tests is not allowed. I, being “old school,” have always had a microscope available in the office which allows me to provide some quick answers/additional clues. It is also advantageous to have the lab close by and to hav friendly lab techs who will invite you to come have a look at what they are seeing. This, I suggest, is the true art of medicine and reinforces learning. I often tell residents that “I am a PGY-XX” and that I will always be a student.This year I announce that “I am a PGY- 43 11/12” as I ignore the eye rolling and the “under the breath” snickering.And that brings us to today’s two medical mysteries as I invite you and a virtual resident toÂ reenact your version of Sherlock Holmes/Columbo.
Resources/Additional reading (alphabetical order)
Gupta D, Gupta R. Green urine. ScientificWorldJOURNAL. 2011;11: 1101–1102. https://www.researchgate.net/publication/51175592_Green_Urine
La Manna A, Polito C, Marte A, et al. Hyperuricosuria in children: clinical presentation and natural history. Pediatrics. 2001; 107:
Prakash S, Saini S, Mullick P, Pawar M. Green urine: A cause for concern? J Anaesthesiol Clin Pharmacol. 2017;33:128-130. doi: 10.4103/0970-9185.202190. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5374818/
Raymond JR, Yarger WE. Abnormal urine color: differential diagnosis. South Med J. 1988;81:837-41. https://www.ncbi.nlm.nih.gov/pubmed/?term=Abnormal+Urine+Color%2C+Raymond+JR%2C+Yarger+WE%2C+South+Med+J