Figure 1: Click on image to enlarge
IMAGE OF THE WEEK 2012
WEEK 2
ORANGE URINE DISCOLOURATION FROM RIFAMPICIN
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Figure 1: Click on image to enlarge |
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Urine discolouration in clinical practice is not uncommon and can be alarming to patients, family and even healthcare workers including nurses and doctors.
In this case, the discolouration is from rifampicin, a medication used in the treatment of tuberculosis and occasionally used for other non-tuberculous infections such as Staphyloccocus infection and also for chemoprophylaxis post meningitis (Nesseria meningitides) exposure.
Urine discolouration can be due to pathological conditions but is often due to medications, certain foods or food dyes. Normal urine is commonly straw coloured that can be light (diluted urine) to dark straw colour (concentrated urine). It can even be colourless if large amount of water is consumed. List of conditions including medications and food/food dyes that can cause discolouration is shown in the Table below.
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Conditions |
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Red/pink |
Blood |
- Pathology of the urinary tract - Bleeding diatheses: from medications such as anticoagulation or congenital/acquired - Post instrumentations/catheterisation |
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Greenish brown |
Bilirubin |
- Biliary pathology (obstructive jaundice) - Hepatic disorders leading to jaundice |
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Dark brown/Black (Coca Cola urine) |
Myoglobin |
- Rhabdomyolysis from any causes |
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Cloudy |
Cellular debris/protein |
- Urinary tract infection - Diabetic nephropathy/pre-eclampsia |
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Blue/green |
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- Familial hypercalcemia - Urinary tract infection (Pseudomonas spp) |
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Medications |
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Dark/Brown
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Ferrous salt/iron dextran |
Chloroquine |
Levodopa |
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Nitrates |
Methyldopa |
Quinines |
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Metronidazole |
Nitrofurantion |
Senna |
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Sulphonamides |
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Yellow Brown
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Chloroquine |
Metronidazole |
Bismuth |
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Nitrofurantion |
Primaquine |
Senna |
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Sulphonamides |
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Blue/blue green
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Methylene blue |
Amitriptyline |
Triamterene |
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Indomethacin |
Propofol |
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Orange/yellow
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Rifampicin |
Sulphasalazine |
Warfarin |
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Heparin |
Dihydroergotamine |
Phenazopyridine |
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Pyridium |
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Red/pink
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Heparin |
Methyldopa |
Phenytoin |
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Phenothiazines |
Senna |
Salicylates |
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Ibuprofen |
Daunorubicin/doxorubicin |
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Neon yellow |
Vitamin B |
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Green |
Vitamin B |
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Foods/food dyes/toxins |
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Red/pink (haematuria like)
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Beet root |
Berries |
Rhubarb |
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Chronic lead or mercury poisoning |
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Dark brown/tea coloured |
Fava beans |
Rhubarb |
Aloe |
Note: discolouration from food is usually due to consumption of large amount of the food
Rifampicin also causes orange yellow discolouration of other secretions such as sweat and tears.
Clinicians need to be aware that condition like the purple urine bag syndrome is not due to discolouration of the urine rather that discolouration of the urine bag due to precipitations of pigments reacting with the urine bag.
Image and text contributed and prepared by
Dr Vui Heng Chong, Department of Internal Medicine, RIPAS Hospital, Brunei Darussalam.
All images are copyrighted and property of RIPAS Hospital.
