Vin Rose Urine

A 17-year-old girl presented to the emergency department with abdominal pain, nausea and vomiting, and diarrhea approximately 9 hours after swallowing 25 tablets (200 mg each) of iron sulfate in a suicide attempt. Her vital signs were within normal limits. She was mildly lethargic; stool was hemoccult-positive.

Laboratory analyses were unremarkable except for a serum iron level of 444 µg/dL. The patient was given fluids intravenously. Iron chelation therapy with deferoxamine mesylate was initiated; 3 intramuscular doses (a total of 2 g) were given over 12 hours. After the therapy, the patient was asymptomatic; her recovery proceeded uneventfully.

Drs Michael Sternberg and Shane O'Neill of the University of South Alabama Medical Center in Mobile point out that complications of iron toxicity can include GI hemorrhage, shock, metabolic acidosis, coagulopathy, hepatic failure, and late bowel obstruction. Appropriate therapy incorporates intravenous hydration and symptomatic care and may include whole bowel irrigation and/or chelation therapy.

The iron-deferoxamine chelate, ferrioxamine, is excreted renally with an elimination half-life of about 6 hours. Characteristically, "vin ros," or deep red winecolored, urine is produced. The appearance of "vin ros" urine has been used as a marker for iron toxicity in patients who have ingested unidentified substances and who undergo a "deferoxamine challenge test."

The disappearance of the vin ros urine is one indication that chelation therapy may be discontinued.

Although "vin ros" urine is still commonly referred to in discussions of iron toxicity, the deep red color is rarely if ever seen in clinical practice. The color that predominates is an orange or pink to reddish-brown hue that resembles what most clinicians consider merely concentrated urine. Despite adequate hydration and an uneventful hospital course, this patient's serial urine samples exhibited a medium amber not red wine color that persisted until the iron chelate was cleared at about 37 hours.