Unusual Green Urine Caused by Propofol A Benign But Rare Clinical Observation

Introduction

Green-tinted urine is an alarming but often benign phenomenon that can arise during medical treatment. In a rare case from Dhulikhel Hospital, Nepal, a patient sedated with the anesthetic drug propofol developed green-colored urine—a side effect that is not widely known but clinically harmless. This blog explores the case, its context, and implications for anesthesia practice.

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Case Background Organophosphate Poisoning and Sedation

A 33-year-old male patient was admitted to the ICU after ingesting a toxic mixture of chlorpyrifos and cypermethrin, leading to organophosphorus poisoning with aspiration pneumonia. His condition required mechanical ventilation, and sedation was initially managed with fentanyl and midazolam.

• After 10 days, sedation was shifted to propofol at 30 μg/kg/min.
• Six hours later, his urine turned a distinct green color.
• The discoloration resolved within five hours after discontinuing the propofol infusion.

A detailed analysis can be found in our main journal article.

Understanding the Science Behind Green Urine

Propofol is primarily metabolized in the liver into phenolic compounds, which are then excreted via the urine. These phenolic metabolites, such as 1-glucuronide and 4-glucuronide, are responsible for the green discoloration.

• This side effect is very rare, occurring in <1% of patients.
• The urine pH, organ function, and lab values were within normal ranges, confirming no serious underlying pathology.
• The condition is not linked to propofol infusion syndrome, a more dangerous complication.

Broader Medical Context

The American Society of Anesthesiologists (ASA) emphasizes that awareness of medication-related changessuch as urine discoloration can prevent unnecessary testing and patient anxiety. Similar cases have noted green urine in patients administered methocarbamol, methylene blue, and amitriptyline, among others

Interactions Worth Noting

In this case, atropine infusion, a key part of organophosphorus poisoning treatment, may have played a role by reducing gastrointestinal motility, thus impairing enterohepatic circulation. This could have led to reduced metabolism of propofol in the liver, contributing to metabolite accumulation and urine discoloration.

Healthcare professionals should be mindful of such drug interactions, especially during prolonged ICU sedation.

Read the Full Study

To explore the full clinical findings, including biochemical data and images, access the original case report at:
https://doi.org/10.29328/journal.ijcar.1001024

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https://www.anesthesiaresjournal.com/

Conclusion and Clinical Insight

Green urine resulting from propofol administration is rare but entirely harmless. Recognizing this side effect can spare patients and caregivers from undue concern. In intensive care settings where drug combinations are common, clinicians must stay informed about such rare reactions to ensure accurate diagnosis and appropriate responses.

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