It was a road accident case, and the plating in the arm was done under General anaesthesia. The surgery was successful, but two or three hours later, when the patient was recovering in the post-operative ward, the nursing staff were alarmed to find his urine was of dark green colour, similar to spinach juice.
In very few cases ever recorded, a patient at a Mumbai hospital, India reacted to a common anaesthetic drug by passing dark green urine.
“We have come across the cases in medical literature but not in the professional career,” said Dr Jitendra Bhawalkar.
The doctors ran a battery of tests on the patient, but all the results were normal, despite the persistently green urine.
There was no problem with the patient’s renal and liver functions, and neither was there any evidence of a urinary tract infection (UTI).
“An old drug cimetidine [used to treat acidity] and certain antidepressants are known to cause green discolouration of urine,” said Dr Hemal Shah, adding that it was possible that the change in colour could be due to a condition known as myoglobinuria (release of a protein myglobinuria in blood due to muscle damage).
Finally, the doctors realized that the patient was having an extremely rare reaction to the intravenous anaesthetic drug, propofol. There are only two recorded cases in medical literature of a patient reacting to propofol by discharging green urine.
The green colour of urine due to Propofol occurs when clearance of Propofol exceeds hepatic elimination, and extrahepatic elimination of Propofol occurs. This discolouration of urine is a rare (less than 1% cases) but a benign side effect of Propofol, which is non-nephrotoxic and gets reversed after discontinuation of the drug.
The patient and his urine were closely monitored for the next three days, after which the latter returned to its normal colour. He has since been discharged and is recovering “very well”.
Since the incidence of green urine is so rare, a report case was published in the June 10 issue of British Medical Journal.
“Since neither did the patient suffer from UTI nor did any of the drugs received by him were known to cause green urine, we finally suspected that propofol, a drug which was used for general anaesthesia would be the sole reason,” wrote the doctors in their report. “Return of the urine to its normal colour coupled with a normal urinalysis confirmed our suspicion of propofol being the cause of the phenomena.”
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