Pink urine syndrome (pus): a case report
Mourad Ababou, Ayoub Boubekri, Noureddine Kartite, Abdelhafid Houba, Nawfal Doghmi, Hicham Bakkali
Corresponding author: Mourad Ababou, Department of Anesthesiology and Intensive Care, Miltary Hospital Mohammed V, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco
Received: 10 May 2020 - Accepted: 18 May 2020 - Published: 02 Jun 2020
Domain: Emergency medicine,Intensive care medicine
Keywords: Pink urine syndrome, propofol, uric acid, diabetes
©Mourad Ababou et al. PAMJ - Clinical Medicine (ISSN: 2707-2797). This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Cite this article: Mourad Ababou et al. Pink urine syndrome (pus): a case report. PAMJ - Clinical Medicine. 2020;3:35. [doi: 10.11604/pamj-cm.2020.3.35.23394]
Available online at: https://www.clinical-medicine.panafrican-med-journal.com/content/article/3/35/full
Pink urine syndrome (PUS): a case report
Mourad Ababou1,&, Ayoub Boubekri1, Noureddine Kartite1, Abdelhafid Houba1, Nawfal Doghmi1, Hicham Bakkali1
1Department of Anesthesiology and Intensive Care, Military Hospital Mohammed V, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco
Mourad Ababou, Department of Anesthesiology and Intensive Care, Miltary Hospital Mohammed V, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco
The PUS (pink urine syndrome) is a disorder of low frequency, described by sudden presence of pink urine distinguishable from hematuria, because of its lighter tone and to leave sediment of this shading while centrifuging. There is no definite occurrence and just reports of secluded cases. Urine analysis revealed low pH in the various cases and pink sediment was shown to contain many uric acid crystals. The mechanism of this fascinating phenomenon is not clearly understood, but some factors have been associated with the increased excretion of uric acid in urine such as obesity, use of propofol, antidiuretic hormone, dehydration, surgical stress, abdominal surgeries, among others. We describe a case of propofol-induced pink urine syndrome and discuss the factors leading to this syndrome.
Pink urine syndrome is a rare syndrome characterized by the presence of pink urine and sediment of this color when centrifuging . This syndrome is principally seen after a propofol anesthesia. It can be confused with hematuria or food pink urine, but urine analysis eliminates the presence of heme and finds abundant crystals of uric acid giving the urine this color.
A 56-year-old man (body mass index 27.77Kg/m2; 85kg) with type 2 diabetes undergoing insulin therapy, current smokers with 20 pack-years and alcoholic, was admitted to intensive care unit with septic shock and acute respiratory failure. Due to hypoxia, respiratory acidosis and hypotension, the patient was intubated, using propofol and rocuronium for induction. The following day, we noticed the presence of pink urine, as well as sediment of the same color (Figure 1). There was no hematuria or traumatic urinary history. In standard blood analysis we found hemoglobin 12.8g/dL; leukocytes 16.000/mm3; platelets 182,000; CRP 187; PCT 3.11; glucose 2.1 g/dL; creatinine 7mg/L; urea 0.5 g/L; ASAT 139; ALAT 34; Total bilirubin 6; Na 140mmol; K 4.2mmol; Cl 107mmol. In Urine analysis, protein, nitrite, white cells, ketone, and blood were absent. The urine cultures were negative for microbial growth. The pH was 6 with a high concentration of uric acid. Pink color tended to disappear in the next day without any specific therapy. The patient was evolved well and extubated on the third day of his admission thanks to the immediately management of his septic shock and to the control of infection with appropriate antibiotics.
In 1996 a milky-pink urine was seen in 9 Japanese patients after propofol anesthesia , since then cases studies have been published with the aim of understanding the mechanism of appearance of this color in the urine, as well as the predisposing factors (Table 1). Most patients are obese males , alcoholics , have undergone surgery [2,3,5], were given propofol [1-5], have a low urine pH. Insulin resistance is also found in many patients with this syndrome [1,3]. The appearance of pink urine requires several conditions [1,6]: a chronic hyperuricemia favoring Uricosuria, especially in obese patients; Acid urine, Oliguria and high urinary osmolarity favor uricosuria; the increase in the antidiuretic hormone and the surgical stress linked to steroids (cortisone), condition the precipitation of uric acid crystals, acting like uricosurics; The use of propofol causes an increase in the excretion of urates, which can condition pink urine; An adequate GFR: required for clearance of uric acid; Chronic oxidative stress, increases bilirubin production. We suggest that our case of PUS was due to the use of propofol in a patient with predisposing factors like dehydration, alcohol and insulin resistance. In different cases published (Table 1), Pink urine syndrome is considered to be a benign condition which, in most cases, does not require specific treatment and is generally resolved spontaneously.
This syndrome remains rare and requires the combination of several factors. However, this is a syndrome that may prompt us to look for the presence of predisposing factors such as the use of propofol, alcoholism, hyperuricemia, dehydration and others. without being serious in itself. its resolution is spontaneous. We can also conclude from our case that obesity is often founded but not an essential factor for its onset.
The authors declare no competing interests.
All the authors have read and agreed to the final manuscript.
Table 1: pink urine syndrome case studies published in the literature
Figure 1: pink urine and pink sediment stain the urine collection bag
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