Christmas-colored urine in vasoplegic shock
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IMAGING IN INTENSIVE CARE MEDICINE
Christmas‑colored urine in vasoplegic shock Govind Pandompatam* and Muhammad Qaseem © 2020 Springer-Verlag GmbH Germany, part of Springer Nature
A 73-year-old male underwent redo mitral valve replacement. Cardiopulmonary bypass time was prolonged and the case was complicated by significant hypotension. He arrived to the ICU on multiple vasopressors in refractory vasoplegic shock. Methylene blue was administered and then high-dose hydroxocobalamin as salvage agents. These agents are nitric oxide scavengers and their use has increased in the treatment of vasoplegic syndrome. Both agents can cause benign changes to urine color. The patient’s urine was first noted to be green-blue as is commonly seen with methylene blue administration. After administration of hydroxocobalamin, urine color then changed to a maroon-red, also a known side effect of this medication, which can last for over a week. These distinct color changes were visualized in the foley bag, correlating with timing of administration (Fig. 1, black arrow). Over the next 24 h, shock improved and the patient was weaned off vasopressors and made a complete recovery.
Fig. 1 Urine of a 73-year old male in vasoplegic shock. Black arrow points to the distinct color changes seen after administration of methylene blue and then hydroxocobalamin. Christmas-Colored Urine in Vasoplegic Shock
Compliance with ethical standards Conflict of interest On behalf of all authors, the corresponding author states that there is no conflict of interest.
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Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. *Correspondence: [email protected] HSHS Saint John’s Hospital, Springfield, IL, USA
Received: 15 June 2020 Accepted: 1 July 2020
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