Patient Presentation
A 9-year-old boy is brought to the clinic because of brightly colored orange urine that he noticed this morning when he urinated after sleeping.
He has had one other urination this morning that was also bright orange in color. He had no pain, frequency or urgency. His mother states that he has been drinking well and feeling well.
He was started on Rifampin yesterday by a local public health official after the child seated next to him at school each day was diagnosed with Neisseria meningititis.
The family history and review of systems are negative including no rash, fever, headache or trauma.
The pertinent physical exam shows a normally developed child with normal vital signs and a negative examination.
The laboratory evaluation showed a bright orange colored urine that had a pH of 6.5, specific gravity of 1.015 with 0-1 white blood cells and was otherwise normal.
The diagnosis of rifampin colored urine was made and the patient and family was reassured.
They were also counseled about symptoms to watch for and the need to seek medical care promptly because of the Neisseriaexposure.
Discussion
Neisseria meningitis is highly invasive with an attack rate for household contacts of 500-800 times higher than the general population.
Therefore, close contacts should ideally receive chemoprophylaxis within 24 hours of diagnosis of the primary case.
High risk contacts include:
- Household contacts especially young children
- Child care or nursery school contacts within the past 7 days
- Direct exposure to secretions
- Mouth to mouth resuscitation
- Frequently slept or ate in same dwelling
- Passengers seated directly next to the index case for more than 8 hours on airline flights
Recommendations for expanded immunization coverage for Neisseria meningitis were made in 2005.
Most urine color changes are harmless.
They often are due to eating particular food or drugs.
Usually parents can be reassurred that once the child stops ingesting the offending agent, the urine will return to normal color in a short time.
Sometimes infections or other medical problems cause color changes. Some urine color changes occur over time as the urine sits and is exposed to oxygen.
Learning Point
The causes of urine color changes include:
- Red/Burgundy Urine
- Old urine
- Hemoglobin
- Red blood cells
- Urates
- Phenolphthalein
- Beets
- Blackberries
- Food coloring
- Serratia marcescens infection
- Orange Urine
- Bile
- Urates
- Warfarin
- Rifampin
- Rifabutin
- Phenzopyridine
- Congo red dye
- Yellow Urine
- Dehydration
- Deep Yellow/Yellow Brown Urine
- Bile
- Bilirubin
- Anti-malarial drugs
- Cascara
- Metronidazole
- Nitrofurantoin
- Sulfasalazine
- Riboflavin
- Carotene-containing foods
- B-complex vitamins
- Green/Blue Urine
- Biliverdin
- Hypercalcemia
- Blue Diaper Syndrome
- Amitriptyline
- Triamterene
- Prochloperazine
- Doxorubicin
- Indomethacin
- Pseudomonas infection
- Indigo blue dye
- Methylene blue dye
- Copper clasp on diaper holder
- Black Urine
- Old blood
- Hemogentistic urine
- Melanin
- Myoglobin
- Hemosiderin
- Tyrosinosis
- Melanosis
- Quinine
- Nitrofurantoin
- Metronidazole
- Cascara
- Senna
- Rhubarb
Questions for Further Discussion
1. When should health care professionals receive chemoprophylaxis for Neisseria meningitis?
Related Cases
- Disease
- Symptom/Presentation
- Age
To Learn More
To view pediatric review articles on this topic from the past year check PubMed.
Information prescriptions for patients can be found at MedlinePlus for this topic: Kidney Diseases
and at Pediatric Common Questions, Quick Answers for this topic: Stool and Urine Color Changes
To view current news articles on this topic check Google News.
Illingworth RS. Common Symptoms of Disease in
Children. Blackwell Scientific Publications: Oxford. 1998. pp. 95, 97.
Schiff D, Shelov SP. American
Academy of Pediatrics. The Official, Complete Home Reference:
Guide to Your Child’s Symptoms. Villard: New York. 1997. pp. 587.
Sheldon SH Levy HB. Pediatric
Differential Diagnosis, Second Edition. Raven Press: New
York. 1985. pp. 22, 156.
American Academy of Pediatrics. Meningococcal Infections, In Pickering LD, Baker CJ, Long SS, McMillan JA, eds. Red Book: 2006 Report of the Committee on Infectious Diseases. 27th edit. Elk Grove Village, IL: American Academy of Pediatrics; 2006;452-460.
ACGME Competencies Highlighted by Case
1. When interacting with patients and their families, the health care professional communicates effecively and demonstrates caring and respectful behaviors.
2. Essential and accurate information about the patients is gathered.
3. Informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment is made.
4. Patient management plans are developed and carried out.
5. Patients and their families are counseled and educated.
8. Health care services aimed at preventing health problems or maintaining health are provided.
9. Patient-focused care is provided by working with health care professionals, including those from other disciplines.
10. An investigatory and analytic thinking approach to the clinical situation is demonstrated.
11. Basic and clinically supportive sciences appropriate to their discipline are known and applied.
12. Evidence from scientific studies related to the patients’ health problems is located, appraised and assimilated.
13. Information about other populations of patients, especially the larger population from which this patient is drawn, is obtained and used.
24. Cost-effective health care and resource allocation that does not compromise quality of care is practiced.
25. Quality patient care and assisting patients in dealing with system complexities is advocated.
26. Partnering with health care managers and health care providers to assess, coordinate, and improve health care and how these activities can affect system performance are known.
Author
Donna M. D’Alessandro, MD
Associate Professor of Pediatrics, Children’s Hospital of Iowa
Date
August 28, 2006
Pediatric Education 