purple pee

  1. 0
    Tonight in clinical we had something happen that none of us had an answer for. A pt. had purple urine. I am talking Barney the Dinosaur purple. Yes I saw it , and no I wasn't on anything!!!
    Here's what I know, as it was not my pt., I was only there to assist.
    foley catheter
    Very obese pt--350 lbs. at least
    addmitted w hyponatremia (I believe)
    palliative care
    We had gone in to tidy her up as she had been bowel incontinent, and to change cath bag. As I watched, some dark, bloody urine drained, and then this bright purple. I was so shocked, I checked the tube to make sure that it was indeed the cath tube. Whatever it was coated the clear tube and completely blocked the foley, necessitating a change. None of the nurses could figure out the purple colour, though.
    Any suggestions?
  2. 9 Comments so far...

  3. 0
    I've heard of this but the details are a bit fuzzy, it was a long time ago. I think it's associated with pt's who have long term catheters insitu and susceptible to infection. If my memory serves me well, it's not actually the urine that turns purple, but the catheter tubing. I think it's something that's present in the urine that stains the tubing and bag.

    Tina
  4. 0
    Could be the meds the patient is on .
  5. 0
    Maybe it was something they ate? :uhoh21:
  6. 1
    I found an article that backs up letina's answer.
    Interesting......


    http://jcp.bmjjournals.com/cgi/content/full/54/5/412-a


    A case of purple urine bag syndrome associated with Providencia rettgeri
    M A Al-Jubouri and M S Vardhan
    Department of Chemical Pathology and Microbiology, St Helens and Knowsley Hospitals NHS Trust, Warrington Road, Prescot, Merseyside L35 5DR, UK


    We would like to report this interesting case of an elderly lady (85 years old) who has been passing violet coloured urine over the past four weeks. She is living in a nursing home and has a long term urinary catheter. There were no other symptoms but her general practitioner was worried about urine discolouration and sent three urine samples to the biochemistry department on three separate occasions to identify the cause of the violet colour. There was no history of intake of medication, food colouring, or special food items that may alter the urine colour. The urine sample was alkaline (pH 8.5) with a strong smell of ammonia. It was centrifuged and a precipitate of fine blue crystals was identified in the sediment. The supernatant was clear and purple coloured, and was negative for haemoglobin, myoglobin, and porphyrins. At this stage, the purple urine bag syndrome (PUBS) was suspected and an aliquot was sent to microbiology for culture and sensitivity. There was heavy growth of a coliform species identified as Providencia rettgeri, an ammonia producing bacterium, adding support to the diagnosis of PUBS. This interesting phenomenon in which the urinary catheter of some elderly patients develops intense purple colouration is thought to be caused by indirubin formation.1 Various observers stated that indigo producing bacteria, which possess indoxyl sulphatase activity, usually bring about the decomposition of urinary indoxyl sulphate to indigo and indirubin.1, 2 Several bacterial species have been reported in association with PUBS including Escherichia coli, Proteus mirabilis, Morganella morganii, Klebsiella pnemoniae, and Providencia stuarti.15 Providencia rettgeri was isolated from our patient; to our knowledge this organism has not been reported previously in PUBS cases. Awareness and prompt identification of this syndrome by biochemistry and microbiology departments should avoid them performing unnecessary tests on such urine samples.
    TXNurse4life likes this.
  7. 0
    Cool! Thanks Leesiebug
  8. 0
    Thanks you, thank you, thank you :hatparty:
    Great information. I'll take it to clinical next week, and share it.
    Amazing the things that happen!!!!
  9. 0
    Quote from LeesieBug
    I found an article that backs up letina's answer.
    Interesting......


    http://jcp.bmjjournals.com/cgi/content/full/54/5/412-a


    A case of purple urine bag syndrome associated with Providencia rettgeri
    M A Al-Jubouri and M S Vardhan
    Department of Chemical Pathology and Microbiology, St Helens and Knowsley Hospitals NHS Trust, Warrington Road, Prescot, Merseyside L35 5DR, UK

    We would like to report this interesting case of an elderly lady (85 years old) who has been passing violet coloured urine over the past four weeks. She is living in a nursing home and has a long term urinary catheter. There were no other symptoms but her general practitioner was worried about urine discolouration and sent three urine samples to the biochemistry department on three separate occasions to identify the cause of the violet colour. There was no history of intake of medication, food colouring, or special food items that may alter the urine colour. The urine sample was alkaline (pH 8.5) with a strong smell of ammonia. It was centrifuged and a precipitate of fine blue crystals was identified in the sediment. The supernatant was clear and purple coloured, and was negative for haemoglobin, myoglobin, and porphyrins. At this stage, the purple urine bag syndrome (PUBS) was suspected and an aliquot was sent to microbiology for culture and sensitivity. There was heavy growth of a coliform species identified as Providencia rettgeri, an ammonia producing bacterium, adding support to the diagnosis of PUBS. This interesting phenomenon in which the urinary catheter of some elderly patients develops intense purple colouration is thought to be caused by indirubin formation.1 Various observers stated that indigo producing bacteria, which possess indoxyl sulphatase activity, usually bring about the decomposition of urinary indoxyl sulphate to indigo and indirubin.1, 2 Several bacterial species have been reported in association with PUBS including Escherichia coli, Proteus mirabilis, Morganella morganii, Klebsiella pnemoniae, and Providencia stuarti.15 Providencia rettgeri was isolated from our patient; to our knowledge this organism has not been reported previously in PUBS cases. Awareness and prompt identification of this syndrome by biochemistry and microbiology departments should avoid them performing unnecessary tests on such urine samples.

    Ah, I knew this was familiar!! I actually work at St Helens and Knowsley where the above case was reported.
    Tina
  10. 0
    I have a patient (home health) that reported to me twice some time ago that her urine was black. 2 separate episodes and none since, I never heard of this and the Doc didn't seemed concerned. She had no catheter. And I never saw it. She's not one to make stuff up and she's not confused. Got any ideas?
  11. 0
    Quote from letina
    Ah, I knew this was familiar!! I actually work at St Helens and Knowsley where the above case was reported.
    Tina

    Wow ! Interesting !

    Always learn something new here ! Love it !
    Thank you !


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