Results 1 to 10 of 10

Hybrid View

  1. #1
    Join Date
    Feb 2010
    Location
    NJ
    Posts
    301
    Points
    4,478
    Level
    1
    Downloads
    13
    Uploads
    0


    Did you find this post helpful? Yes | No

    Default Propofol toxicity? Green urine?

    Hello all, I transported a patient from a community hospital to my larger facility vented and sedated on a small dose of propofol at 15mL/hr (10mg/mL). He was awake but calm. There were no complications during transport, but when I got to the SICU they looked at his urine and said he is having propofol toxicity. His urine had a very slight green tint that I did not notice. In a brief lit search I found a paper that said it did not have any clinical significance and was not related to renal damage. When the propofol stopped within 2-4 hrs the urine became normal again. Has anyone encountered this? Is this really propofol toxicity? He had none of the signs of propofol infusion syndrome and had only been on it for <24 hrs at a low dose. He had swallowed his dentures and they were stuck in his lower esophagus and had been unable to be retrieved by ENT or and EGD.

    I tried to post this in the clinical section but was having difficulty.

  2. #2
    Join Date
    Aug 2009
    Location
    FL
    Posts
    891
    Points
    8,515
    Level
    1
    Downloads
    5
    Uploads
    0


    Did you find this post helpful? Yes | No

    Default

    I've taken care of plenty of patients on propofol gtts where the urine turned green. Doesn't mean they are having a propofol syndrome. Check an abg and if no acidosis I wouldn't worry too much. It happens


    Sent from my iPhone using GasTalk

  3. #3
    Join Date
    Sep 2009
    Location
    Louisiana
    Posts
    4,762
    Points
    20,831
    Level
    1
    Downloads
    1
    Uploads
    0


    Did you find this post helpful? Yes | No

    Default

    Just tell them "thank God you are here!" and walk away.
    Being offended is the ultimate form of narcissism
    My brother http://markmichell.com/
    His band http://www.scalethesummit.com/
    On youtube http://www.youtube.com/watch?v=EJEKs5lSfIw

  4. #4
    Join Date
    Oct 2010
    Location
    New England
    Posts
    352
    Points
    4,599
    Level
    1
    Downloads
    1
    Uploads
    0


    2 out of 2 members found this post helpful. Did you find this post helpful? Yes | No

    Default

    We see the green tint often. Doesn't mean PRIS. Here is CE article you can print and leave with them.....
    http://ccn.aacnjournals.org/content/28/3/18.full

    also from medscape CE
    Propofol is metabolized in the liver and excreted in urine predominantly as the 1-glucuronide, 4-glucuronide, and 4-sulfate conjugates of 2,6-diisopropyl-1,4 quinol.[18] Green discoloration of urine is attributed to the presence of these phenolic metabolites. In addition to urine, reports of green discoloration of the hair and liver after propofol administration implicate these phenols.[19, 20] The metabolites do not reflect or alter renal function.[10] Although they are of no clinical significance, they do serve as an indicator of relative urine pH where alkalinization increases and acidification decreases formation of these phenolic deriva-tives.[
    Last edited by ABCRn; 02-24-2012 at 01:21 PM. Reason: ignoring my kids

  5. #5
    Join Date
    Feb 2010
    Location
    NJ
    Posts
    301
    Points
    4,478
    Level
    1
    Downloads
    13
    Uploads
    0


    Did you find this post helpful? Yes | No

    Default

    Thank you all for the helpful info! I did read the medscape study. I had not seen the AACN article. Thank you.

  6. #6
    Join Date
    May 2007
    Posts
    2,373
    Points
    13,881
    Level
    1
    Blog Entries
    1
    Downloads
    1
    Uploads
    0


    Did you find this post helpful? Yes | No

    Default

    Quote Originally Posted by deemo21 View Post
    Hello all, I transported a patient from a community hospital to my larger facility vented and sedated on a small dose of propofol at 15mL/hr (10mg/mL). He was awake but calm. There were no complications during transport, but when I got to the SICU they looked at his urine and said he is having propofol toxicity. His urine had a very slight green tint that I did not notice. In a brief lit search I found a paper that said it did not have any clinical significance and was not related to renal damage. When the propofol stopped within 2-4 hrs the urine became normal again. Has anyone encountered this? Is this really propofol toxicity? He had none of the signs of propofol infusion syndrome and had only been on it for <24 hrs at a low dose. He had swallowed his dentures and they were stuck in his lower esophagus and had been unable to be retrieved by ENT or and EGD.

    You can really show your mettle as an aspiring anesthetist by explaining that there really is no such thing as propofol toxicity. Misuse by people not prepared to deal with the consequences of using the agent, maybe. PRIS is an adverse reaction to the drug, not toxicity.

  7. #7
    Join Date
    Jul 2006
    Location
    Albany NY
    Posts
    12,077
    Points
    39,358
    Level
    1
    Downloads
    0
    Uploads
    0


    Did you find this post helpful? Yes | No

    Default

    Quote Originally Posted by Teillard View Post
    You can really show your mettle as an aspiring anesthetist by explaining that there really is no such thing as propofol toxicity. Misuse by people not prepared to deal with the consequences of using the agent, maybe. PRIS is an adverse reaction to the drug, not toxicity.
    while I don't disagree with what you propose, PRIS has been argued as 'toxiciy'. adverse rxn vs toxicity is argumentative in this situation.
    i got a BA in graphic arts at a local online community college. GPA was 2.7. got into anesthesia by the grace of jeebus. i'm now the best charter in my department -- ca. 2010

  8. #8
    Join Date
    May 2007
    Posts
    2,373
    Points
    13,881
    Level
    1
    Blog Entries
    1
    Downloads
    1
    Uploads
    0


    Did you find this post helpful? Yes | No

    Default

    Quote Originally Posted by ethernaut View Post
    while I don't disagree with what you propose, PRIS has been argued as 'toxiciy'. adverse rxn vs toxicity is argumentative in this situation.

    Ok, fair enough. One of the hats we CRNA's wear is "pharmacologic expert". Where has pris "been argued" as 'toxicity'? Can you defend it? in my pharmacology training, "toxicity" has always meant adverse effects secondary to overdose. Also, while you're at it Ether, for our young (and not so young) aspirants, distinguish between "adverse reaction" and "overdose". To wit: What is the difference between an adverse reaction to fentanyl and an overdose of fentanyl?

  9. #9
    Join Date
    Jul 2006
    Location
    Albany NY
    Posts
    12,077
    Points
    39,358
    Level
    1
    Downloads
    0
    Uploads
    0


    Did you find this post helpful? Yes | No

    Default

    Quote Originally Posted by Teillard View Post
    Ok, fair enough. One of the hats we CRNA's wear is "pharmacologic expert". Where has pris "been argued" as 'toxicity'? Can you defend it? in my pharmacology training, "toxicity" has always meant adverse effects secondary to overdose. Also, while you're at it Ether, for our young (and not so young) aspirants, distinguish between "adverse reaction" and "overdose". To wit: What is the difference between an adverse reaction to fentanyl and an overdose of fentanyl?
    sure, i agree we are 'pharmocolic experts'. we have to be. as for the argument of toxicity vs adverse effect, i can only attest to what i've read in the past and what grand rounds has shown me. let me get some info and i'll pass along what i find out.

    as to defining what adverse effect is, or what overdose is, i think there are some similarities and overlapping. i see it as a grey area, but.. let me posit this.. if an overdose of fentanyl, let's say, causes severe bradycardia, severe hypotension and ultimately asystole, who's to say that an accumulated dose (or even one time dose) can't cause similar reactions? i think we think of overdose as a volume/amount issue, and adverse effect regardless of volume/amount, but i think it goes 'deeper' than that. none the less, i almost took your questions as a tad rhetorical, as they easily can be.
    i got a BA in graphic arts at a local online community college. GPA was 2.7. got into anesthesia by the grace of jeebus. i'm now the best charter in my department -- ca. 2010

  10. #10
    Join Date
    May 2007
    Posts
    2,373
    Points
    13,881
    Level
    1
    Blog Entries
    1
    Downloads
    1
    Uploads
    0


    1 out of 1 members found this post helpful. Did you find this post helpful? Yes | No

    Default

    Quote Originally Posted by ethernaut View Post
    sure, i agree we are 'pharmocolic experts'. we have to be. as for the argument of toxicity vs adverse effect, i can only attest to what i've read in the past and what grand rounds has shown me. let me get some info and i'll pass along what i find out.

    as to defining what adverse effect is, or what overdose is, i think there are some similarities and overlapping. i see it as a grey area, but.. let me posit this.. if an overdose of fentanyl, let's say, causes severe bradycardia, severe hypotension and ultimately asystole, who's to say that an accumulated dose (or even one time dose) can't cause similar reactions? i think we think of overdose as a volume/amount issue, and adverse effect regardless of volume/amount, but i think it goes 'deeper' than that. none the less, i almost took your questions as a tad rhetorical, as they easily can be.
    Teasing out minutia, splitting hairs, and beating dead horses have a place in refining a point. We're teaching here. I know you know the big picture and I also know people casually throw out terms that they think mean one thing, but mean another. Discussions like these are valuable even though on their face, they may appear trivial. Thanks for playing along, E.

 

 

Similar Threads

  1. Green ouside theatre
    By dr.abdulaziz in forum Anesthesia Adjunct Review
    Replies: 22
    Last Post: 05-15-2009, 07:21 PM
  2. Urine Drug Tests for Doctors?
    By MmacFN in forum Passing Gas
    Replies: 9
    Last Post: 11-25-2008, 06:48 PM
  3. Drinking urine is awesome!
    By Burnt2 in forum Passing Gas
    Replies: 6
    Last Post: 10-19-2008, 06:15 AM
  4. Green Laser
    By nojrevorg in forum Passing Gas
    Replies: 6
    Last Post: 02-11-2008, 04:32 AM

Tags for this Thread

Bookmarks

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  

More Information