Case description

We report the case of a 77-year old woman with atypical intracerebral hemorrhage that was treated with mild hypothermia in addition to osmotic therapy. The patient’s urine subsequently showed a green discoloration. Urine discoloration was completely reversible upon discontinuation of propofol.

Discussion and evaluation

Propofol-related urine discoloration may have been provoked by hypothermia. Due to the benign nature of this side effect, propofol should be stopped and gastrointestinal function should be supported.

Conclusion

More studies are needed to show a causal role of hypothermia and related decreased enzymatic function

A Bodenham

AD Weinberg

BD Ku

Brain Trauma Foundation

C Ananthanarayan

CK Tan

D Staykov

DW Barbara

F Ehrig

F Pak

G Carpenito

HH Kaufman

KA McGurk

KA Tonseth

KH Polderman

MJ Gillett

N Shioya

P Bernante

PJ Simons

Y Oda

SpringerPlus

PubMed

Regensburger, Martin

Huttner, Hagen B.

Doerfler, Arnd

Schwab, Stefan

Staykov, Dimitre

OPUS FAU - Online-Publikationssystem der Friedrich-Alexander-Universität Erlangen-Nürnberg

Propofol-related urine discoloration in a patient with fatal atypical intracerebral hemorrhage treated with hypothermia

Case description
We report the case of a 77-year old woman with atypical intracerebral hemorrhage that was treated with mild hypothermia in addition to osmotic therapy. The patient’s urine subsequently showed a green discoloration. Urine discoloration was completely reversible upon discontinuation of propofol.
Discussion and evaluation
Propofol-related urine discoloration may have been provoked by hypothermia. Due to the benign nature of this side effect, propofol should be stopped and gastrointestinal function should be supported.
Conclusion
More studies are needed to show a causal role of hypothermia and related decreased enzymatic function

Regensburger, Martin

Huttner, Hagen B.

Doerfler, Arnd

Schwab, Stefan

Staykov, Dimitre

OPEN FAU Online-Publikationssystem der Friedrich-Alexander-Universität Erlangen-Nürnberg

a SpringerOpen JournalRegensburger et al. SpringerPlus 2014, 3:551http://www.springerplus.com/content/3/1/551CASE STUDY Open AccessPropofol-related urine discoloration in a patientwith fatal atypical intracerebral hemorrhagetreated with hypothermiaMartin Regensburger1,2*, Hagen B Huttner1, Arnd Doerfler3, Stefan Schwab1 and Dimitre Staykov1AbstractIntroduction: Mild therapeutic hypothermia is an increasingly recognised treatment option to reduce perihemorrhagicedema in severe intracerebral hemorrhage.Case description: We report the case of a 77-year old woman with atypical intracerebral hemorrhage that was treatedwith mild hypothermia in addition to osmotic therapy. The patient’s urine subsequently showed a green discoloration.Urine discoloration was completely reversible upon discontinuation of propofol.Discussion and evaluation: Propofol-related urine discoloration may have been provoked by hypothermia. Dueto the benign nature of this side effect, propofol should be stopped and gastrointestinal function should besupported.Conclusion: More studies are needed to show a causal role of hypothermia and related decreased enzymatic function.Keywords: Hypothermia; Intracerebral hemorrhage; Urine discoloration; Enterohepatic circulation; Liver enzyme functionCaseA 77-year old woman was referred to our hospital be-cause of acute hemiparesis of the left side. A cerebralCT scan revealed an intracerebral hemorrhage with avolume of 32 milliliter located in the right parietal cortexwith concomitant right hemispheric subarachnoid bloodaccumulation (Figure 1A). Due to rapid worsening ofthe paresis and her consciousness, she was orotracheallyintubated and started on imaging, Figure 1B) showedsignificant worsening. An external ventricular drainagewas surgically put in place to prevent hydrocephalusand to control intracerebral pressure. Follow-up MRI re-vealed an increased size of the bleeding to 112 milliliter,large perifocal edema and a midline shift of 9 millimeter.Susceptibility weighted images revealed multiple micro-bleeds as a correlate of amyloid angiopathy as mostprobable cause of the hemorrhage (Figure 1C). Therewas no evidence for other causes of the initial event and* Correspondence: martin.regensburger@uk-erlangen.de1Department of Neurology, University of Erlangen-Nuremberg,Schwabachanlage 6, 91054 Erlangen, Germany2Division of Molecular Neurology, University of Erlangen-Nuremberg,Schwabachanlage 6, 91054 Erlangen, GermanyFull list of author information is available at the end of the article© 2014 Regensburger et al.; licensee Springer.Commons Attribution License (http://creativecoreproduction in any medium, provided the origfor the expansion of the hematoma: Blood coagulationparameters were within normal limits, there was nohistory of arterial hypertension. Under the influcence ofanalgosedatives, blood pressure had to be supported bycontinuous infusion of norepinephrine and did not exceeda systolic pressure of 160 mmHg and a mean arterialblood pressure of 100 mmHg diastolic. Echocardiographywas unremarkable.Due to the age of the patient, a decision was madeagainst surgical hematoma evacuation and for aggressivemedical treatment. To reduce edema, osmotic therapywith mannitol and hypertonic saline was started. Serumosmolality was thereby increased to 330 mosmol/kg witha sodium level of 150 mmol/l. As an additional anti-edema therapy, mild therapeutic hypothermia (35,0°C)was induced with an endovascular cooling catheter(Staykov et al. 2013).86 hours after the onset of analgosedatives and 16 hoursafter induction of hypothermia, we noted a green-browndiscoloration of the patient’s urine (Figure 2A). Standardurine analysis was unremarkable (pH 6,5, protein neg.,nitrite neg., wbc neg., ketone neg., bilirubine neg., bloodneg.) and urine cultures were negative. Liver functionThis is an Open Access article distributed under the terms of the Creativemmons.org/licenses/by/4.0), which permits unrestricted use, distribution, andinal work is properly credited.Figure 1 Neuroradiological imaging results in the presented patient. A: CT-imaging on admission. B: CT-control-imaging 4 hours later. C: Susceptibilityweighted MRI after 1 day. D: CT-imaging 4 days after admission and before termination of osmotic therapy and therapeutic hypothermia.Regensburger et al. SpringerPlus 2014, 3:551 Page 2 of 4http://www.springerplus.com/content/3/1/551parameters including bilirubin were normal. At the sametime, obstipation in presence of enteral feeding via a naso-gastral tube was treated with laxatives. Analgosedativeswere switched to midazolame and sufentanil, and propofol(total amount of 14,000 mg, average infusion rate ofFigure 2 Urine samples of the patient. A: Dark green discoloration 48 hohours after the end of propofol administration.3.2 mg/kg/h) was discontinued. Within few hours, urinecolor changed back to normal (Figure 2B).Despite maximal therapy, CT follow-up after 3 daysshowed significant worsening with increased edema,mesencephalic compression and subfalcine and uncalurs after the onset of propofol. B: Color changed back to normal fewRegensburger et al. SpringerPlus 2014, 3:551 Page 3 of 4http://www.springerplus.com/content/3/1/551herniation (Figure 1D). Due to poor prognosis, osmotictherapy was stopped and the patient died two days laterdue to cerebral herniation.DiscussionUrine discoloration due to propofol infusion has beendescribed few times in the literature (Bodenham et al.1987; Tan et al. 2008; Ku et al. 2011; Shioya et al. 2011;Barbara and Whalen 2012). Potential other causes includeamitriptyline, indomethacin, cimetidine, metoclopramide,methocarbamol and promethazine as well as urinary tractinfection or food coloring (Carpenito and Kurtz 2002;Ehrig et al. 1999; Pak 2004; Gillett and Burnett 2006;Tonseth et al. 2007; Bernante et al. 2003; Ananthanarayanand Fisher 1995). Few of these constellations reflect aharmful situation per se and neither health care staff norrelatives should be alarmed. If urine analysis is normal, theaccountable drug should be identified by pausing medica-tions that are known for this side effect.To the best of our knowledge, this is the first reportdescribing urine discoloration in a patient treated withosmotic therapy and mild hypothermia. Hypothermia isalso known to increase the risk of tubular dysfunction,electrolyte loss and electrolyte disorders and this may bepotentiated by the renal side effects of osmotic therapy(Brain Trauma Foundation 2007; Polderman et al. 2001a;Polderman et al. 2001b; Kaufman et al. 1993; Weinberg1993). However, in our patient, creatinine and urea levelsremained at baseline levels throughout her disease courseand serial arterial blood analyses showed normal pH levels.Hypothermia reduces the metabolic rate by 7–9% per de-gree Celsius reduction of body temperature (Polderman2004). Propofol is metabolized by hepatic and renal glu-curonidation (Oda et al. 2001; McGurk et al. 1998). Themechanism of propofol-induced urine discoloration issupposed to be mediated by extrahepatic propofol glu-curonidation due to decreased hepatic glucuronidationas a consequence of reduced liver enzyme function ordiminished peristalsis (Shioya et al. 2011). The greencolor is a consequence of the excretion of the quinolderivates 4-(2,6-diisopropyl-1,4-quinol)-sulphate, 1- and4-(2,6-diisopropyl-1,4)-glucuronide resulting from renalsulfo- and glucuroconjugation of propofol (Simons et al.1988).We assume that decreased liver enzyme functiondue to hypothermia, decreased enterohepatic circulationdue to obstipation and a high-normal rate of propofolanalgosedation may have provoked urine discolorationin our patient. Although urine discoloration is regardedas a benign side effect of propofol, we conclude that careshould be taken in patients treated with hypothermia tomaintain renal function and peristalsis. Future studiesare needed to show interactions of hypothermia with theobserved side effect of propofol.ConsentDue to the fatal outcome, written informed consent forthe publication of this report could not be obtained fromthe patient; therefore all images are anonymized.Competing interestsM. Regensburger, H.B. Huttner, A. Doerfler, S. Schwab and D. Staykov declarethat they have no competing interests.Authors’ contributionMR, HBH, SS and DS performed in-hospital care of the patient; MR and DSwrote the manuscript; AD provided neuroradiological images. All authorsread and approved the final manuscript.Author details1Department of Neurology, University of Erlangen-Nuremberg,Schwabachanlage 6, 91054 Erlangen, Germany. 2Division of MolecularNeurology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054Erlangen, Germany. 3Department of Neuroradiology, University ofErlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany.Received: 4 March 2014 Accepted: 16 September 2014Published: 23 September 2014ReferencesAnanthanarayan C, Fisher JA (1995) Why was the urine green? Can J Anaesth42:87–88Barbara DW, Whalen FX, Jr (2012) Propofol induction resulting in green urinediscoloration. Anesthesiology 116:924Bernante P, Francini F, Zangrandi F, et al. (2003) Green urine after intragastric balloonplacement for the treatment of morbid obesity. Obes Surg 13:951–953Bodenham A, Culank LS, Park GR (1987) Propofol infusion and green urine.Lancet 2:740Brain Trauma Foundation, American Association of Neurological Surgeons,Congress of Neurological Surgeons (2007) Guidelines for themanagement of severe traumatic brain injury. J Neurotrauma24(Suppl 1):S1–S106Carpenito G, Kurtz I (2002) Green urine in a critically ill patient. Am J Kidney Dis 39:E20Ehrig F, Waller S, Misra M, Twardowski ZJ (1999) A case of ‘green urine’. NephrolDial Transplant 14:190–192Gillett MJ, Burnett JR (2006) Medications and green urine. Intern Med J 36:64–66Kaufman HH, Timberlake G, Voelker J, Pait TG (1993) Medical complications ofhead injury. Med Clin North Am 77:43–60Ku BD, Park KC, Yoon SS (2011) Dark green discoloration of the urine afterprolonged propofol infusion: a case report. J Clin Pharm Ther36:734–736McGurk KA, Brierley CH, Burchell B (1998) Drug glucuronidation byhuman renal UDP-glucuronosyltransferases. Biochem Pharmacol55:1005–1012Oda Y, Hamaoka N, Hiroi T, Imaoka S, Hase I, Tanaka K, Funae Y, Ishizaki T, AsadaA (2001) Involvement of human liver cytochrome P4502B6 in themetabolism of propofol. Br J Clin Pharmacol 51:281–285Pak F (2004) Green urine: an association with metoclopramide. Nephrol DialTransplant 19:2677Polderman KH (2004) Application of therapeutic hypothermia in theintensive care unit. Opportunities and pitfalls of a promising treatmentmodality–Part 2: Practical aspects and side effects. Intensive Care Med30:757–769Polderman KH, Girbes AR, Peerdeman SM, Vandertop WP (2001a) Hypothermia.J Neurosurg 94:853–858Polderman KH, Peerdeman SM, Girbes AR (2001b) Hypophosphatemia andhypomagnesemia induced by cooling in patients with severe head injury.J Neurosurg 94:697–705Shioya N, Ishibe Y, Shibata S, Makabe H, Kan S, Matsumoto N, Takahashi G,Yamada Y, Endo S (2011) Green urine discoloration due to propofol infusion:a case report. Case Rep Emerg Med 2011:242514Simons PJ, Cockshott ID, Douglas EJ, Gordon EA, Hopkins K, Rowland M (1988)Disposition in male volunteers of a subanaesthetic intravenous dose of an oilin water emulsion of 14C-propofol. Xenobiotica 18:429–440Regensburger et al. SpringerPlus 2014, 3:551 Page 4 of 4http://www.springerplus.com/content/3/1/551Staykov D, Wagner I, Volbers B, Doerfler A, Schwab S, Kollmar R (2013) Mildprolonged hypothermia for large intracerebral hemorrhage. Neurocrit Care18:178–183Tan CK, Lai CC, Cheng KC (2008) Propofol-related green urine. Kidney Int 74:978Tonseth KA, Tindholdt TT, Hokland BM, Abyholm FE (2007) Green urine aftersurgical treatment of pressure ulcer. Scand J Plast Reconstr Surg Hand Surg41:39–41Weinberg AD (1993) Hypothermia. Ann Emerg Med 22:370–377doi:10.1186/2193-1801-3-551Cite this article as: Regensburger et al.: Propofol-related urinediscoloration in a patient with fatal atypical intracerebral hemorrhagetreated with hypothermia. SpringerPlus 2014 3:551.Submit your manuscript to a journal and benefi t from:7 Convenient online submission7 Rigorous peer review7 Immediate publication on acceptance7 Open access: articles freely available online7 High visibility within the fi eld7 Retaining the copyright to your article    Submit your next manuscript at 7 springeropen.com

Martin Regensburger

Hagen B. Huttner

Arnd Doerfler

Stefan Schwab

Dimitre Staykov

Crossref

a SpringerOpen JournalRegensburger et al. SpringerPlus 2014, 3:551http://www.springerplus.com/content/3/1/551CASE STUDY Open AccessPropofol-related urine discoloration in a patientwith fatal atypical intracerebral hemorrhagetreated with hypothermiaMartin Regensburger1,2*, Hagen B Huttner1, Arnd Doerfler3, Stefan Schwab1 and Dimitre Staykov1AbstractIntroduction: Mild therapeutic hypothermia is an increasingly recognised treatment option to reduce perihemorrhagicedema in severe intracerebral hemorrhage.Case description: We report the case of a 77-year old woman with atypical intracerebral hemorrhage that was treatedwith mild hypothermia in addition to osmotic therapy. The patient’s urine subsequently showed a green discoloration.Urine discoloration was completely reversible upon discontinuation of propofol.Discussion and evaluation: Propofol-related urine discoloration may have been provoked by hypothermia. Dueto the benign nature of this side effect, propofol should be stopped and gastrointestinal function should besupported.Conclusion: More studies are needed to show a causal role of hypothermia and related decreased enzymatic function.Keywords: Hypothermia; Intracerebral hemorrhage; Urine discoloration; Enterohepatic circulation; Liver enzyme functionCaseA 77-year old woman was referred to our hospital be-cause of acute hemiparesis of the left side. A cerebralCT scan revealed an intracerebral hemorrhage with avolume of 32 milliliter located in the right parietal cortexwith concomitant right hemispheric subarachnoid bloodaccumulation (Figure 1A). Due to rapid worsening ofthe paresis and her consciousness, she was orotracheallyintubated and started on imaging, Figure 1B) showedsignificant worsening. An external ventricular drainagewas surgically put in place to prevent hydrocephalusand to control intracerebral pressure. Follow-up MRI re-vealed an increased size of the bleeding to 112 milliliter,large perifocal edema and a midline shift of 9 millimeter.Susceptibility weighted images revealed multiple micro-bleeds as a correlate of amyloid angiopathy as mostprobable cause of the hemorrhage (Figure 1C). Therewas no evidence for other causes of the initial event and* Correspondence: martin.regensburger@uk-erlangen.de1Department of Neurology, University of Erlangen-Nuremberg,Schwabachanlage 6, 91054 Erlangen, Germany2Division of Molecular Neurology, University of Erlangen-Nuremberg,Schwabachanlage 6, 91054 Erlangen, GermanyFull list of author information is available at the end of the article© 2014 Regensburger et al.; licensee Springer.Commons Attribution License (http://creativecoreproduction in any medium, provided the origfor the expansion of the hematoma: Blood coagulationparameters were within normal limits, there was nohistory of arterial hypertension. Under the influcence ofanalgosedatives, blood pressure had to be supported bycontinuous infusion of norepinephrine and did not exceeda systolic pressure of 160 mmHg and a mean arterialblood pressure of 100 mmHg diastolic. Echocardiographywas unremarkable.Due to the age of the patient, a decision was madeagainst surgical hematoma evacuation and for aggressivemedical treatment. To reduce edema, osmotic therapywith mannitol and hypertonic saline was started. Serumosmolality was thereby increased to 330 mosmol/kg witha sodium level of 150 mmol/l. As an additional anti-edema therapy, mild therapeutic hypothermia (35,0°C)was induced with an endovascular cooling catheter(Staykov et al. 2013).86 hours after the onset of analgosedatives and 16 hoursafter induction of hypothermia, we noted a green-browndiscoloration of the patient’s urine (Figure 2A). Standardurine analysis was unremarkable (pH 6,5, protein neg.,nitrite neg., wbc neg., ketone neg., bilirubine neg., bloodneg.) and urine cultures were negative. Liver functionThis is an Open Access article distributed under the terms of the Creativemmons.org/licenses/by/4.0), which permits unrestricted use, distribution, andinal work is properly credited.Figure 1 Neuroradiological imaging results in the presented patient. A: CT-imaging on admission. B: CT-control-imaging 4 hours later. C: Susceptibilityweighted MRI after 1 day. D: CT-imaging 4 days after admission and before termination of osmotic therapy and therapeutic hypothermia.Regensburger et al. SpringerPlus 2014, 3:551 Page 2 of 4http://www.springerplus.com/content/3/1/551parameters including bilirubin were normal. At the sametime, obstipation in presence of enteral feeding via a naso-gastral tube was treated with laxatives. Analgosedativeswere switched to midazolame and sufentanil, and propofol(total amount of 14,000 mg, average infusion rate ofFigure 2 Urine samples of the patient. A: Dark green discoloration 48 hohours after the end of propofol administration.3.2 mg/kg/h) was discontinued. Within few hours, urinecolor changed back to normal (Figure 2B).Despite maximal therapy, CT follow-up after 3 daysshowed significant worsening with increased edema,mesencephalic compression and subfalcine and uncalurs after the onset of propofol. B: Color changed back to normal fewRegensburger et al. SpringerPlus 2014, 3:551 Page 3 of 4http://www.springerplus.com/content/3/1/551herniation (Figure 1D). Due to poor prognosis, osmotictherapy was stopped and the patient died two days laterdue to cerebral herniation.DiscussionUrine discoloration due to propofol infusion has beendescribed few times in the literature (Bodenham et al.1987; Tan et al. 2008; Ku et al. 2011; Shioya et al. 2011;Barbara and Whalen 2012). Potential other causes includeamitriptyline, indomethacin, cimetidine, metoclopramide,methocarbamol and promethazine as well as urinary tractinfection or food coloring (Carpenito and Kurtz 2002;Ehrig et al. 1999; Pak 2004; Gillett and Burnett 2006;Tonseth et al. 2007; Bernante et al. 2003; Ananthanarayanand Fisher 1995). Few of these constellations reflect aharmful situation per se and neither health care staff norrelatives should be alarmed. If urine analysis is normal, theaccountable drug should be identified by pausing medica-tions that are known for this side effect.To the best of our knowledge, this is the first reportdescribing urine discoloration in a patient treated withosmotic therapy and mild hypothermia. Hypothermia isalso known to increase the risk of tubular dysfunction,electrolyte loss and electrolyte disorders and this may bepotentiated by the renal side effects of osmotic therapy(Brain Trauma Foundation 2007; Polderman et al. 2001a;Polderman et al. 2001b; Kaufman et al. 1993; Weinberg1993). However, in our patient, creatinine and urea levelsremained at baseline levels throughout her disease courseand serial arterial blood analyses showed normal pH levels.Hypothermia reduces the metabolic rate by 7–9% per de-gree Celsius reduction of body temperature (Polderman2004). Propofol is metabolized by hepatic and renal glu-curonidation (Oda et al. 2001; McGurk et al. 1998). Themechanism of propofol-induced urine discoloration issupposed to be mediated by extrahepatic propofol glu-curonidation due to decreased hepatic glucuronidationas a consequence of reduced liver enzyme function ordiminished peristalsis (Shioya et al. 2011). The greencolor is a consequence of the excretion of the quinolderivates 4-(2,6-diisopropyl-1,4-quinol)-sulphate, 1- and4-(2,6-diisopropyl-1,4)-glucuronide resulting from renalsulfo- and glucuroconjugation of propofol (Simons et al.1988).We assume that decreased liver enzyme functiondue to hypothermia, decreased enterohepatic circulationdue to obstipation and a high-normal rate of propofolanalgosedation may have provoked urine discolorationin our patient. Although urine discoloration is regardedas a benign side effect of propofol, we conclude that careshould be taken in patients treated with hypothermia tomaintain renal function and peristalsis. Future studiesare needed to show interactions of hypothermia with theobserved side effect of propofol.ConsentDue to the fatal outcome, written informed consent forthe publication of this report could not be obtained fromthe patient; therefore all images are anonymized.Competing interestsM. Regensburger, H.B. Huttner, A. Doerfler, S. Schwab and D. Staykov declarethat they have no competing interests.Authors’ contributionMR, HBH, SS and DS performed in-hospital care of the patient; MR and DSwrote the manuscript; AD provided neuroradiological images. All authorsread and approved the final manuscript.Author details1Department of Neurology, University of Erlangen-Nuremberg,Schwabachanlage 6, 91054 Erlangen, Germany. 2Division of MolecularNeurology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054Erlangen, Germany. 3Department of Neuroradiology, University ofErlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany.Received: 4 March 2014 Accepted: 16 September 2014Published: 23 September 2014ReferencesAnanthanarayan C, Fisher JA (1995) Why was the urine green? Can J Anaesth42:87–88Barbara DW, Whalen FX, Jr (2012) Propofol induction resulting in green urinediscoloration. Anesthesiology 116:924Bernante P, Francini F, Zangrandi F, et al. (2003) Green urine after intragastric balloonplacement for the treatment of morbid obesity. Obes Surg 13:951–953Bodenham A, Culank LS, Park GR (1987) Propofol infusion and green urine.Lancet 2:740Brain Trauma Foundation, American Association of Neurological Surgeons,Congress of Neurological Surgeons (2007) Guidelines for themanagement of severe traumatic brain injury. J Neurotrauma24(Suppl 1):S1–S106Carpenito G, Kurtz I (2002) Green urine in a critically ill patient. Am J Kidney Dis 39:E20Ehrig F, Waller S, Misra M, Twardowski ZJ (1999) A case of ‘green urine’. NephrolDial Transplant 14:190–192Gillett MJ, Burnett JR (2006) Medications and green urine. Intern Med J 36:64–66Kaufman HH, Timberlake G, Voelker J, Pait TG (1993) Medical complications ofhead injury. Med Clin North Am 77:43–60Ku BD, Park KC, Yoon SS (2011) Dark green discoloration of the urine afterprolonged propofol infusion: a case report. J Clin Pharm Ther36:734–736McGurk KA, Brierley CH, Burchell B (1998) Drug glucuronidation byhuman renal UDP-glucuronosyltransferases. Biochem Pharmacol55:1005–1012Oda Y, Hamaoka N, Hiroi T, Imaoka S, Hase I, Tanaka K, Funae Y, Ishizaki T, AsadaA (2001) Involvement of human liver cytochrome P4502B6 in themetabolism of propofol. Br J Clin Pharmacol 51:281–285Pak F (2004) Green urine: an association with metoclopramide. Nephrol DialTransplant 19:2677Polderman KH (2004) Application of therapeutic hypothermia in theintensive care unit. Opportunities and pitfalls of a promising treatmentmodality–Part 2: Practical aspects and side effects. Intensive Care Med30:757–769Polderman KH, Girbes AR, Peerdeman SM, Vandertop WP (2001a) Hypothermia.J Neurosurg 94:853–858Polderman KH, Peerdeman SM, Girbes AR (2001b) Hypophosphatemia andhypomagnesemia induced by cooling in patients with severe head injury.J Neurosurg 94:697–705Shioya N, Ishibe Y, Shibata S, Makabe H, Kan S, Matsumoto N, Takahashi G,Yamada Y, Endo S (2011) Green urine discoloration due to propofol infusion:a case report. Case Rep Emerg Med 2011:242514Simons PJ, Cockshott ID, Douglas EJ, Gordon EA, Hopkins K, Rowland M (1988)Disposition in male volunteers of a subanaesthetic intravenous dose of an oilin water emulsion of 14C-propofol. Xenobiotica 18:429–440Regensburger et al. SpringerPlus 2014, 3:551 Page 4 of 4http://www.springerplus.com/content/3/1/551Staykov D, Wagner I, Volbers B, Doerfler A, Schwab S, Kollmar R (2013) Mildprolonged hypothermia for large intracerebral hemorrhage. Neurocrit Care18:178–183Tan CK, Lai CC, Cheng KC (2008) Propofol-related green urine. Kidney Int 74:978Tonseth KA, Tindholdt TT, Hokland BM, Abyholm FE (2007) Green urine aftersurgical treatment of pressure ulcer. Scand J Plast Reconstr Surg Hand Surg41:39–41Weinberg AD (1993) Hypothermia. Ann Emerg Med 22:370–377doi:10.1186/2193-1801-3-551Cite this article as: Regensburger et al.: Propofol-related urinediscoloration in a patient with fatal atypical intracerebral hemorrhagetreated with hypothermia. SpringerPlus 2014 3:551.Submit your manuscript to a journal and beneﬁ t from:7 Convenient online submission7 Rigorous peer review7 Immediate publication on acceptance7 Open access: articles freely available online7 High visibility within the ﬁ eld7 Retaining the copyright to your article    Submit your next manuscript at 7 springeropen.com

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Propofol-related urine discoloration in a patient with fatal atypical intracerebral hemorrhage treated with hypothermia

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