A Man With Black Urine
Article Outline
[Ann Emerg Med. 2009;53:836.]
A 45-year-old man presented to the emergency department at Veterans General Hospital, Taipei, Taiwan, with shortness of breath after unknown chemical solution ingestion. The medical history was remarkable only for chronic alcoholism. He had a decreased consciousness level and was cold and clammy. A “medicinal” odor was smelled. Initial treatment included tracheal intubation, gastric lavage, activated charcoal administration, and aggressive fluid resuscitation. When a urinary catheter was placed, black urine was drained (Figure).
Figure.
Black urine in Foley bag. Used with permission of Chun-Chi Lin, Division of Clinical Toxicology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Diagnosis
Cresol intoxication. The urine levels of para-cresol, meta-cresol, ortho-cresol, and phenol were 10,186, 11,015, 388, and 101 mg/g creatinine, respectively, at 12 hours after ingestion. The methemoglobin level was 1.1%, with a hemoglobin concentration of 14.8 g/dL. His hospitalization course was complicated by pneumonia, gastric corruption, and liver and renal function impairment. He recovered uneventfully after intensive supportive care.
Cresol, a commonly used household disinfectant worldwide, was the original active ingredient in the American brand Lysol. It may cause gastrointestinal corrosive injury, central nervous system and cardiovascular disturbances, and renal and hepatic injury after intoxication.1 When ingested, cresol is excreted in the urine and renal damage is possible. The black urine is a prominent feature of cresol intoxication. Other different diagnoses of black urine include hemoglobinuria, myoglobinuria, alkaptonuria, melanuria, porphyrinuria, and tyrosinuria. In addition, some medications including l-dopa, methyldopa, chloroquine, primaquine, furazolidone, metronidazole, nitrofurantoin, cascara/senna laxatives, methocarbamol, and sorbitol may cause black urine.2, 3
Initial management includes gross decontamination, activated charcoal use, and case-based decision for gastric lavage. Medical treatment of cresol intoxication is primarily supportive to maintain cardiovascular and respiratory functions. Hemodialysis is indicated in acute renal failure.1, 4 Benzodiazepine and anticonvulsants can be used if seizures occur.
References
For the diagnosis and teaching points, see page 843
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PII: S0196-0644(08)01976-8
doi:10.1016/j.annemergmed.2008.10.031
© 2008 Published by Elsevier Inc.
