Citation

Chindarkar NS, Rentmeester LL, Ly BT, Fitzgerald RL. Clin. Biochem. 2014; 47(12): 1132-1135.

Copyright

(Copyright © 2014, Elsevier Publishing)

DOI

10.1016/j.clinbiochem.2014.03.016

PMID

unavailable

Abstract

OBJECTIVES: Systemic exposure to drugs, chemicals and foods can cause abnormally colored urine. Food exposures are typically benign, but urine discoloration due to chemicals or drugs may indicate a potentially dangerous condition. Discolored urine can also be caused by medical problems. This brief report reviews the laboratory findings leading to lactic acidosis and elevated urine urobilinogen in an alcoholic patient with pellagra. Design and methods: A 66-year-old male, found unconscious in his hotel room, was brought to the emergency department (ED). Upon arrival he had hypothermia, a diffuse rash and altered mental status. During ED evaluation, a urinary catheter was placed and demonstrated black urine. Medical history noted chronic alcoholism, malnutrition, and poor self-care.

RESULTS: Evaluation in the hospital suggested that his rash and neurologic changes were a result of malnutrition and vitamin deficiency. A thorough biochemical workup demonstrated that elevated urobilinogen was likely causing the patient's black urine. Serum niacin concentration was undetectable. His dermatitis improved with multivitamins, thiamine, and niacin as well as topical steroids. His mental status returned to baseline and he was discharged to a skilled nursing facility following a brief hospital stay.

CONCLUSIONS: The patient's abnormal laboratory results were explained by his alcoholism and poor nutrition. Furthermore, urine color returned to normal with decreased concentration of urobilinogen, after vitamin supplementation and supportive medical care. © 2014 The Canadian Society of Clinical Chemists.

Language: en

Keywords

Humans; Aged; Male; human; male; alcohol; hypothermia; aged; resuscitation; alcoholism; case report; malnutrition; suicide attempt; complication; hospitalization; environmental exposure; Alcoholism; alcohol intoxication; Lactic acidosis; substance abuse; alcohol abuse; alcohol consumption; article; mental disease; priority journal; thrombocytopenia; emergency ward; steroid; albumin; albumin blood level; sepsis; hospital discharge; computer assisted tomography; erythema; alcohol blood level; rash; steroid therapy; hypernatremia; medical care; glucose blood level; emphysema; alanine aminotransferase; aspartate aminotransferase; antibiotic agent; glucose; bicarbonate; protein blood level; sodium; sodium blood level; core temperature; liver dysfunction; self care; folic acid; dermatitis; infusion fluid; multivitamin; thiamine; urine; lactic acidosis; calcium; antibiotic therapy; lactate blood level; liver disease; calcium blood level; pellagra; unconsciousness; hemoglobin; medical history; thrombocyte count; bilirubin; bilirubin blood level; hemoglobin blood level; alanine aminotransferase blood level; aspartate aminotransferase blood level; anion gap; Bilirubin; fatty liver; atopic dermatitis; urine color; alkaline phosphatase blood level; wakefulness; abnormal laboratory result; hematocrit; carbon dioxide tension; urine level; osmolality; warming; vitamin supplementation; seborrheic dermatitis; lactic acid; nicotinic acid; bicarbonate blood level; blood pH; alkaline phosphatase; chloride; chloride blood level; lichenoid eruption; black urine; Black urine; protein urine level; nicotinic acid deficiency; Pellagra; skin fissure; urinary catheter; bilirubin glucuronide; hyperosmolality; urobilinogen; Urobilinogen