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RED URINE to all but the color blind is an attention-getting event. The patient is likely to seek help quickly but will seldom bring the urine with him. Questions about color often yield colorful answers that leave the physician tinged with uncertainty. The first rule follows: try hard to obtain a sample of the discolored urine. The corollary of this rule is to interpret the word "red" loosely enough to encompass orange, pink, red, brown, and black. The inclusion of brown-black allows for situations in which contact with urine changes blood pigments into differently colored derivatives. Assuming that one obtains the sample of red urine, the second rule is invoked: separate the possibilities into heme pigments (positive occult blood tests) and all others (negative occult blood tests).
There are three clinical possibilities—hematuria (RBCs), hemoglobinuria (from an elevated plasma hemoglobin), and myoglobinuria (from skeletal muscle damage).
The easiest to recognize
Berman LB. When the Urine is Red. JAMA. 1977;237(25):2753–2754. doi:10.1001/jama.1977.03270520063032
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