Revollo Jane Y, Lowder Jeffrey C, Pierce Andrew S, Twilla Jennifer D
Methodist University Hospital, Memphis, TN, USA.
University of Tennessee Health Science Center College of Medicine, Memphis, TN, USA.
J Pharm Technol. 2014 Apr;30(2):54-56. doi: 10.1177/8755122513500921. Epub 2014 Feb 28.
To report a case of metronidazole-induced urine discoloration in a patient with sepsis. A 52-year old man was admitted with sepsis secondary to colitis, which developed after he had been recently treated with broad-spectrum antibiotics for community-acquired pneumonia. The infection was treated with metronidazole, and the patient subsequently developed cola-colored urine. When metronidazole was inadvertently stopped for 34 hours, the urine color returned to normal, but again darkened when the medication was restarted. The patient suffered no clinically adverse effects from the abnormal urine color. He completed the treatment course for colitis and was discharged to home. Urine discoloration is a known side of metronidazole. However, it has been poorly reported in the literature, and many clinicians are unaware that it may happen. Here we report the case of a patient who developed dark urine while receiving treatment with metronidazole. Other potential causes of the urine discoloration were explored, including hemolysis, rhabdomyolysis, or adverse reactions to other medications, with no clear positive findings. An objective causality assessment (Naranjo probability scale) revealed that the urine discoloration was probably due to metronidazole. Metronidazole can cause urine discoloration without otherwise harming the patient. Clinicians should be aware of this potential side effect and provide reassurance to patients who develop abnormal urine that there are no clinically relevant adverse outcomes.
报告一例脓毒症患者甲硝唑诱发尿液变色的病例。一名52岁男性因结肠炎继发脓毒症入院，其结肠炎在近期因社区获得性肺炎接受广谱抗生素治疗后发生。感染采用甲硝唑治疗，随后患者出现可乐色尿液。当甲硝唑意外停用34小时后，尿液颜色恢复正常，但重新用药时尿液颜色再次变深。患者未因尿液颜色异常出现临床不良反应。他完成了结肠炎的治疗疗程并出院回家。尿液变色是甲硝唑已知的副作用。然而，文献中对此报道较少，许多临床医生并不知道可能会发生这种情况。在此我们报告一例在接受甲硝唑治疗时出现深色尿液的患者病例。我们探究了尿液变色的其他潜在原因，包括溶血、横纹肌溶解或对其他药物的不良反应，但未发现明确的阳性结果。客观因果关系评估（纳伦霍概率量表）显示尿液变色可能是由甲硝唑引起的。甲硝唑可导致尿液变色，但不会对患者造成其他伤害。临床医生应意识到这种潜在的副作用，并向尿液异常的患者保证不会有临床相关的不良后果。
