Green Urine!? COPYRIGHT © 2013, ALL RIGHTS RESERVED From the Publishers of
Copyright © 2013 Terms of Use The Consult Guys ® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the Consult Guys ® slide sets constitutes copyright infringement.
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
Copyright © 2013 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
Copyright © 2013 Case Labs: CBC: wnl Electrolytes: wnl Renal and hepatic function: wnl Urine analysis Coags normal
Copyright © 2013 Case It was your impression that the risk of surgery was low and you suggest that surgery proceed.
Copyright © 2013 Case Surgery under general endotracheal anesthesia begins At 1.5 hours into surgery her urine color changes from clear yellow to vivid green
Copyright © 2013 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?
Copyright © 2013 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
Copyright © 2013 Red urine in the perioperative period Trauma (foley) Medications Rifampin Pyridium Foods Beets, blackberries, rhubarb
Copyright © 2013 Orange urine in the perioperative period Dehydration Cholestasis, liver disease Medications Rifampin Pyridium
Copyright © 2013 Dark brown urine in the perioperative period Hemolysis Cholestasis, liver disease
Copyright © 2013 Green urine in the perioperative period Urine infection (pseudomonas) Food dyes St Patricks day Asparagus Chlorets
Copyright © 2013 N Engl J Med Oct 5, 1978
Copyright © 2013 N Engl J Med, Jan 25, 1979
Copyright © 2013
COPYRIGHT © 2013, ALL RIGHTS RESERVED Produced by and