Blue Urine - page 2

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I'm a hospice RN and last night I received a call from the patients daughter stating her mom had blue urine, and to prove her point she sent me a video of it, and it looks like blue kool-aid. Has... Read More

  1. by maelstrom143
    Sep 18, '12
    Several causes can include familial hypercalcemia, an infection w/pseudomonas, or indicanuria (if hospice, labs might be off?)
    Abnormal Urine Color - Medical Articles - About Us - Department of Urology - Stanford University School of Medicine
    "BLUE / GREEN
    Blue or green urine may be caused by a blue dye such as methylene blue, a component in several medications (Trac Tabs, Urised, Uroblue) used to reduce symptoms of bladder inflammation or irritation (1,6). Administration of the dye, indigo carmine, turns the urine green and can last for several days if renal function is poor. While more often reported to cause pink urine, the anesthetic, propofol, has also been reported to cause green coloration of the urine (11). Amitriptyline, indomethacin, resorcinol, triamterine, cimetidine, phenergan, and several multivitamins also lend a blue-green tint to the urine (6). An inherited form of high calcium (called "familial hypercalcemia") can result in blue urine, which has lent this disease the nickname "blue diaper syndrome" (12). Another metabolic disorder, indicanuria, can cause blue urine due to tryptophan indole metabolites (12).

    A blue pigment may also be produced by infection with the bacteria Pseudomonas (1,2). Dark green pigmentation, especially if associated with air (known as "pneumaturia"), urinary tract infection, and/or solid particles in the urine, can be caused by bile when there is a fistula between the urinary tract the intestines."

    As to the blue pigmentation:
    http://textbookofbacteriology.net/pseudomonas_2.html
    "One Pseudomonas pigment is probably a determinant of virulence for the pathogen. The blue pigment, pyocyanin, impairs the normal function of human nasal cilia, disrupts the respiratory epithelium, and exerts a proinflammatory effect on phagocytes. A derivative of pyocyanin, pyochelin, is a siderophore that is produced under low-iron conditions to sequester iron from the environment for growth of the pathogen. It could play a role in invasion if it extracts iron from the host to permit bacterial growth in a relatively iron-limited environment. No role in virulence is known for the fluorescent pigments."
    Last edit by maelstrom143 on Sep 18, '12 : Reason: extra info
  2. by billyboblewis
    Sep 18, '12
    It may be proteus mirablis not sure about spelling
  3. by marycarney
    Sep 18, '12
    Slightly OT: Years ago, my baby sister contracted a horrible UTI on her honeymoon camping in the backwoods of the Upper Peninsula. Honeymoon cystitis it used to be called. The country doc up there gave her Urised but forgot to tell her about the blue urine thing.

    That night, she wet the bed in her sleep due to the bladder irritation. Imagine trying to explain THAT to your husband of four days!
  4. by sapphire18
    Sep 18, '12
    My sister had blue poop once when we were little after eating several blue Flinstones push-ups. LOL.

    Also, in an episode of Greys Anatomy a pt with Munchausens had bright blue urine. She was taking birth control pills and some kind of herbal supplement I believe.
  5. by redhead_NURSE98!
    Sep 18, '12
    Yeah Uro Blue.
  6. by malestunurse
    Sep 18, '12
    Usually hospice care patients are under heavy analgesia, my bet is it would be one of those. When you say the pt is taking no medications what do you mean by that?
  7. by Fiona59
    Sep 18, '12
    Quote from CapeCodMermaid
    My son had green poop once when he was 2, but I've never seen blue urine.
    Mine did the same after eating a six pack of blue Gushers!
  8. by loriangel14
    Sep 18, '12
    Does the patient have a catheter? We just had a patient that was on a med that produced an enzyme that gave her bluish urine.



    I found this:

    Bacteria in the urine produces the enzyme indoxyl phosphatase.This converts indoxyl sulphate into red and blue compounds indirubin and indigo.
    Last edit by loriangel14 on Sep 18, '12
  9. by Diamond Nurse
    Sep 18, '12
    I have seen foley cath tubing and drainage bags stain blue. Asked many docs and only one had a semi-decent answer, "maybe it's a bacterial growth?" I have always wondered if there was really ananswer. My patient was in LTC didn't eat or drink anything even remotely blue and hadn't had any tests or Meth. Blue, just dunno...
  10. by TiffyRN
    Sep 18, '12
    I saw an infant with blue-green urine. I was straight cathing an infant (2 weeks old) who was known to have a congenital bladder outlet obstruction & severe hydronephrosis. The first few ml's of urine was blue-green colored. The color quickly changed to clear/yellow then at the end it was pink-tinged. The pink-tinged was not surprising, I'm sure she had off and on hematuria with her q6hr caths and general lack of cooperation. I saw it as did the charge nurse assisting me. When we went to discard the diaper (which we use to catch urine from straight caths, another nurse saw it and commented on it. Her only medications were once daily amoxicillin and q6hrs Bicitra.

    I have seen chronically blue-green urine with a patient who was on methylene blue for UTI prophylaxis but never again until the above incident. When I googled it, one of the non-medication causes listed was infection with pseudomas which sounded like a possibility. I notified the practitioner on call but nothing was done until the next day. They then did a CBC & CRP which which were essentially normal. Another possibility off google was hypercalcemia. I remember her reviewing her labs and I remember her calcium was a titch high (like 0.1- 0.2 above the normal). She was being fed Sim PM 60/40 which is a low-iron formula. It is supposed to be helpful in calcium disorders (both hypo and hyper).
  11. by patekgtech
    Sep 19, '12
    Medications or substances causing Blue urine

    The following drugs, medications, substances or toxins are some of the possible causes of Blue urine as a symptom.
    This list is incomplete and various other drugs or substances may cause your symptoms (see Blue urine). Always advise your doctor of any medications or treatments you are using, including prescription, over-the-counter, supplements, herbal or alternative treatments.
  12. by Esme12
    Sep 19, '12
    Purple urine bag syndrome is a medical syndrome where purple discoloration of urine occurs in people with urinary catheters and co-existent urinary tract infection. Bacteria in the urine produce the enzyme indoxyl phosphatase. This converts indoxyl sulfate in the urine into the red and blue colored compounds indirubin and indigo. The most commonly implicated bacteria are Providencia stuartii, Providencia rettgeri, Klebsiella pneumoniae, Proteus mirabilis, Escherichia coli, Morganella morganii, and Pseudomonas aeruginosa.

    http://harvardpartnersinternational....ters/69,L0312g
  13. by jadelpn
    Sep 19, '12
    I do know that if the patient has mets to the bone, there are changes to the calcium levels to result in blue urine.

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