Blue Urine

[Carebear77]

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 anyone ever seen blue urine and if so what would be the cause if this. Obviously with her being a hospice patient we are not seeking treatment or doing any testing. She is not taking any medication or eating anything that would cause this. I have never seen anything like this before and was curious if anyone else has seen this? Can't wait to hear what you all have to say.

[NotReady4PrimeTime, RN]

Is this lady being tube-fed? In the old days, to assess for aspiration tube-feed formula would have methylene blue mixed in. I haven't seen it used in tube-feeds for many years. I have had blue urine after a laparoscopic procedure where the surgeon thought he'd nicked my bladder. Methylene blue was instilled through a Foley so he could look for leaks. (Thank God he was wrong... but the blue pee was a bit disconcerting!)

Propofol may cause green urine, but this hospice patient wouldn't be getting propofol.

[maelstrom143]

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."

[billyboblewis]

It may be proteus mirablis not sure about spelling

[meanmaryjean, DNP, RN]

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!

[sapphire18]

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.

[redhead_NURSE98!, ADN, BSN]

Yeah Uro Blue.

[malestunurse]

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?

[Fiona59]

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!

[loriangel14, RN]

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.

[Diamond Nurse]

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...

[TiffyRN, BSN, PhD]

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).

[patekgtech]

[h=2]Medications or substances causing Blue urine[/h]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.

Artificial coloring in medications Methylene blue dye - can cause green or blue urine Risanpin - may make urine blue or green color.

• Triamterene