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Green Urine!?
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Copyright © 2013
Case
 A 70 yo woman presents for elective
L4-L5 spine decompression surgery
(back pain)

Healthy
Denies cigarette smoking, FHx, DM, Hypertension.
Unaware of lipid status
 No family hx of thrombotic disorder
 No use of food supplements, additives,

Activity limited by back pain
 Dysuria last week: UA and culture-no infection

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Case
 Preop Exam
 Comfortable
 Ht
5’8”, wt 150 lbs
 BP 120/80 right and left arm, HR 70 (sinus)
 S1, S2 normal, No murmurs, S3, S4
 Abd soft, bowel sounds normal
 Distal pulses intact. No edema
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Case
 Labs:
 CBC:
wnl
 Electrolytes: wnl
 Renal and hepatic function: wnl
 Urine analysis
 Coags normal
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Case
 It was your impression that the risk of
surgery was low and you suggest that
surgery proceed.
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Case
 Surgery under general endotracheal anesthesia
begins
 At 1.5 hours into surgery her urine color changes
from clear yellow to vivid green
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Case
 You are called by the OR staff because you “cleared” her
for surgery. They ask for advice. While surgery is going well
one question is should surgery be terminated?
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Case
Choices :

Terminate the surgery as soon as can safely be done

Continue surgery but get stat liver function studies

Continue surgery but increase iv fluid repletion

Continue surgery and get hemolysis panel

Continue surgery and no further testing
Copyright © 2013
Case






70 yo woman
healthy
L-4, L-5 decompression (elective)
Normal preop labs
Dysuria 1 week ago, UA, urine culture: no
infection
Intraoperative green urine
Copyright © 2013
Clinical significance of perioperative urine color change
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2596703
Copyright © 2013
Red urine in the perioperative period
 Trauma (foley)
 Medications
 Rifampin
 Pyridium
 Foods
 Beets,
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blackberries, rhubarb
Orange urine in the perioperative period
 Dehydration
 Cholestasis, liver disease
 Medications
 Rifampin
 Pyridium
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Dark brown urine in the perioperative period
 Hemolysis
 Cholestasis, liver disease
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Green urine in the perioperative period
 Urine infection (pseudomonas)
 Food dyes
 St
Patricks day
 Asparagus
 Chlorets
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N Engl J Med Oct 5, 1978
Copyright © 2013
N Engl J Med, Jan 25, 1979
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