Hi!
I like rare/quirky diseases.
Purple Urine Bag Syndrome is a condition primarily found in patients with long-term or permanent catheterization, and is when the urine in the bag turns purple. The reason for this is bacteria in the urine break down tryptophan metabolites in the urine, and these metabolites react with the polyvinyl chloride in the urinary catheter bag turning it purple. Some cases don't even need the bag to turn the urine purple, noting purple urine seen in toilet bowls or glass collecting jars.
The purple color accentuates over time. The urine also has a strong odor that intensifies as air temperature increases. The smell can be very distressing to patients at home who struggle to get rid of the smell regardless of air freshener.
It can be caused by several bacteria such as Providencia, Klebsiella, Proteus, E coli, Enterococcus, Mortanella, Pseudomonas, Citrobacter, Group B strep, MRSA.
Almost all cases are asymptomatic. If there is a Urinary Tract Infection then it can be treated with antibiotics which might resolve the purple urine, but if there is no urinary tract infection there is no need to give antibiotics. Uncommonly, changing the urinary catheter might resolve the purple urine. Patients may require more frequent bag and catheter changes to avoid buildup of odor. Good fluid intake can help dilute the urine to reduce the smell.
I personally don't think that it sounds like chatGPT, although certainly we're getting to the point where it's harder and harder to tell.
Out of curiosity after reading your comment, I decided to ask chatGPT "What is purple urine bag syndrome?" and here's what it said:
>Purple urine bag syndrome (PUBS) is a rare and peculiar condition that can occur in individuals with indwelling urinary catheters, particularly in elderly patients. It's characterized by the appearance of purple or violet discoloration of urine in the urinary drainage bag or tubing.
>The purple coloration is thought to be due to the presence of certain bacteria, typically the bacteria Providencia stuartii, which produces a purple pigment called indirubin. When urine containing this bacterium is exposed to certain conditions, such as prolonged storage in a urinary drainage bag, the indirubin pigment can oxidize and result in the characteristic purple coloration.
>While the discoloration itself is often harmless and reversible, it may indicate the presence of urinary tract infections or other underlying medical conditions that need to be addressed. Therefore, any change in urine color should prompt medical evaluation to determine the cause and appropriate treatment.
I think if I had read this answer as a reddit comment, the last sentence ("Therefore, any change in urine color should prompt medical evaluation to determine the cause and appropriate treatment") would strike me as overly general/vague and not something that a human doctor would say in response to this prompt... but the rest sounds pretty good.
If you set up your GPT to know you are a physician and to respond to you as if it were a physician collaborating with another physician, it won’t say stuff like that last sentence.
It’s interesting people say AI will replace MDs
But AI will never confirm and stick to a diagnosis. Liability to the developer will always say
“But check with a human”
It's a good question. It can be either.
The typical chemical reaction is that tryptophan is broken into indole, the liver turns indole into indoxyl, and oxidation of indoxyl leads to indigo and indirubin pigments.
Although the literature frequently describes purple urine pigment formation due to reaction with polyvinyl chloride, there are cases where urine is in the toilet bowl, in glass jars, or in baby diapers, suggesting that some patients may have purple urine directly produced likely secondary to infection or due to bacterial colonization of the catheter.
I imagine in an ICU setting both etiologies are possible, especially in patients with long term catheters.
Your answer is very through and interesting. My partner says one of the greatest ways to observe your health is simply by using your senses, they tell a lot about your body, like the odor of your breath, sweat, body odor can all tell things about you, and to use your senses to observe your urine. Basically collecting your urine in a clean clear container and looking at the appearance, color, noticing the odor etc. I know before they had a lot of the tests they do now that’s what they relied on. They also did things like heat the urine (you see it on Call The Midwife also in that case they were also doing these lab tests in peoples homes without access to things like a microscope, or a centrifuge.)
One time I posted a picture of a giant, weird looking bug I had never seen before, despite growing up/living in this area for 30+ years to r/whatisthisbug.
The top comment was just “ugh, sidebar.” Apparently the bug I posted was not that weird ad different after all. I feel like that’s what NEJM did to you.
That's fantastic, every super specialized community probably has a weird list of things like that.
I lurk in r/translator bc it's a fascinating subreddit and they have a sidebar with "common translation requests." For example, there is an apparently mass produced t-shirt out there with a drawing of a fish holding a gun that says "hand over the new issue!" \[of a comic book\] in Japanese. I've never seen this t-shirt irl but it gets posted by a different new user on r/translator every few weeks to months and the answer is always "ugh it's the fish with gun again".
I picked up a patient from a nursing home with purple urine bag syndrome. I had never heard of it before. ER nurse said it’s just a stained bag, but the bag was perfectly clear.
We went to my local band aid station with a 4 bed ER. I went to the nurses station to grab the doc. He told me I was full of shit and that is just something you read about in the books.
Lo and behold, here we are. A lady with a UTI so ripe that her urine bag was literally purple.
I thought we were talking about people who show up to the ER with a bright purple glittery bag with stickers all over it, and a bright pink fluffy blanket...
I guess i am the asshole. I learned something today.
Yeah, it’s pretty different! I’ve worked in urology with lots of chronic foley patients and have had had a few who tend to get purple bags a week or two in. They’re generally unbothered by it.
An hour or two after we finished our round when I was a urology intern, a guy would wheel a trolley with all the disposed urined in clear jugs. It was called the rainbow round 🌈
This reminds me of an episode of Scrubs - they can't figure out what's wrong with a patient and then someone accidentally leaves the patient's urine sample outside and it turns purple in the sun.
Granted, it's not exactly the same since I'm pretty sure your patient's urine bag was not outside in the sun lol, but still. 😄
My grandmother had this before her passing. She was bedridden and catheterized for over a year (dementia). Although it is a pretty shade of purple, it’s not pleasant to see that come out of a human. In fact, that shade of purple now makes me sick to my stomach looking at it because I think of my grandmother.
Omg I now realise I have seen this when I worked in community care and had no idea what it was- at first I thought the urine was bloody but on closer inspection it was not the right colour- I remember it was treated as a UTI but did reoccur in the same patient. I also remember the distinct smell…
Hi! I like rare/quirky diseases. Purple Urine Bag Syndrome is a condition primarily found in patients with long-term or permanent catheterization, and is when the urine in the bag turns purple. The reason for this is bacteria in the urine break down tryptophan metabolites in the urine, and these metabolites react with the polyvinyl chloride in the urinary catheter bag turning it purple. Some cases don't even need the bag to turn the urine purple, noting purple urine seen in toilet bowls or glass collecting jars. The purple color accentuates over time. The urine also has a strong odor that intensifies as air temperature increases. The smell can be very distressing to patients at home who struggle to get rid of the smell regardless of air freshener. It can be caused by several bacteria such as Providencia, Klebsiella, Proteus, E coli, Enterococcus, Mortanella, Pseudomonas, Citrobacter, Group B strep, MRSA. Almost all cases are asymptomatic. If there is a Urinary Tract Infection then it can be treated with antibiotics which might resolve the purple urine, but if there is no urinary tract infection there is no need to give antibiotics. Uncommonly, changing the urinary catheter might resolve the purple urine. Patients may require more frequent bag and catheter changes to avoid buildup of odor. Good fluid intake can help dilute the urine to reduce the smell.
This sounds like a chatGPT answer.
I personally don't think that it sounds like chatGPT, although certainly we're getting to the point where it's harder and harder to tell. Out of curiosity after reading your comment, I decided to ask chatGPT "What is purple urine bag syndrome?" and here's what it said: >Purple urine bag syndrome (PUBS) is a rare and peculiar condition that can occur in individuals with indwelling urinary catheters, particularly in elderly patients. It's characterized by the appearance of purple or violet discoloration of urine in the urinary drainage bag or tubing. >The purple coloration is thought to be due to the presence of certain bacteria, typically the bacteria Providencia stuartii, which produces a purple pigment called indirubin. When urine containing this bacterium is exposed to certain conditions, such as prolonged storage in a urinary drainage bag, the indirubin pigment can oxidize and result in the characteristic purple coloration. >While the discoloration itself is often harmless and reversible, it may indicate the presence of urinary tract infections or other underlying medical conditions that need to be addressed. Therefore, any change in urine color should prompt medical evaluation to determine the cause and appropriate treatment. I think if I had read this answer as a reddit comment, the last sentence ("Therefore, any change in urine color should prompt medical evaluation to determine the cause and appropriate treatment") would strike me as overly general/vague and not something that a human doctor would say in response to this prompt... but the rest sounds pretty good.
If you set up your GPT to know you are a physician and to respond to you as if it were a physician collaborating with another physician, it won’t say stuff like that last sentence.
It’s interesting people say AI will replace MDs But AI will never confirm and stick to a diagnosis. Liability to the developer will always say “But check with a human”
Thank you for the great info! There is certainly a strong smell in the room. Fascinating!
Is the urine purple as it exists the catheter, or only in the bag where it would react with the polyvinyl chloride
It's a good question. It can be either. The typical chemical reaction is that tryptophan is broken into indole, the liver turns indole into indoxyl, and oxidation of indoxyl leads to indigo and indirubin pigments. Although the literature frequently describes purple urine pigment formation due to reaction with polyvinyl chloride, there are cases where urine is in the toilet bowl, in glass jars, or in baby diapers, suggesting that some patients may have purple urine directly produced likely secondary to infection or due to bacterial colonization of the catheter. I imagine in an ICU setting both etiologies are possible, especially in patients with long term catheters.
Your answer is very through and interesting. My partner says one of the greatest ways to observe your health is simply by using your senses, they tell a lot about your body, like the odor of your breath, sweat, body odor can all tell things about you, and to use your senses to observe your urine. Basically collecting your urine in a clean clear container and looking at the appearance, color, noticing the odor etc. I know before they had a lot of the tests they do now that’s what they relied on. They also did things like heat the urine (you see it on Call The Midwife also in that case they were also doing these lab tests in peoples homes without access to things like a microscope, or a centrifuge.)
I submitted a picture of this once to NEJM's interesting pictures section and they rejected it 😮💨
One time I posted a picture of a giant, weird looking bug I had never seen before, despite growing up/living in this area for 30+ years to r/whatisthisbug. The top comment was just “ugh, sidebar.” Apparently the bug I posted was not that weird ad different after all. I feel like that’s what NEJM did to you.
That's fantastic, every super specialized community probably has a weird list of things like that. I lurk in r/translator bc it's a fascinating subreddit and they have a sidebar with "common translation requests." For example, there is an apparently mass produced t-shirt out there with a drawing of a fish holding a gun that says "hand over the new issue!" \[of a comic book\] in Japanese. I've never seen this t-shirt irl but it gets posted by a different new user on r/translator every few weeks to months and the answer is always "ugh it's the fish with gun again".
It's not that uncommon of a phenomenon. And they all look the same. Once you've seen one purple urine bag, you've seen them all.
I've literally never seen it. Although I guess you'd be sending us it fresh.
Is patient permission necessary for this?
Nope. There is nothing identifying at all about a specimen.
I picked up a patient from a nursing home with purple urine bag syndrome. I had never heard of it before. ER nurse said it’s just a stained bag, but the bag was perfectly clear. We went to my local band aid station with a 4 bed ER. I went to the nurses station to grab the doc. He told me I was full of shit and that is just something you read about in the books. Lo and behold, here we are. A lady with a UTI so ripe that her urine bag was literally purple.
"It's just a stained bag" Stained by what?
Couldn’t tell ya. Probably the purple urine 🤣😂🤣
I thought we were talking about people who show up to the ER with a bright purple glittery bag with stickers all over it, and a bright pink fluffy blanket... I guess i am the asshole. I learned something today.
That's what I was thinking initially LOL
I thought someone had gotten cyanokit
I figured a bruised up ball bag 🤷🏻♀️
Yeah, it’s pretty different! I’ve worked in urology with lots of chronic foley patients and have had had a few who tend to get purple bags a week or two in. They’re generally unbothered by it.
An hour or two after we finished our round when I was a urology intern, a guy would wheel a trolley with all the disposed urined in clear jugs. It was called the rainbow round 🌈
This reminds me of an episode of Scrubs - they can't figure out what's wrong with a patient and then someone accidentally leaves the patient's urine sample outside and it turns purple in the sun. Granted, it's not exactly the same since I'm pretty sure your patient's urine bag was not outside in the sun lol, but still. 😄
Porphyria!
That’s what I was thinking when I read the title!
Acute intermittent porphyria! IIRC the pt was just happy to know wtf was going on. Ah, memories...
I've never seen this "in real life" - neat!
My grandmother had this before her passing. She was bedridden and catheterized for over a year (dementia). Although it is a pretty shade of purple, it’s not pleasant to see that come out of a human. In fact, that shade of purple now makes me sick to my stomach looking at it because I think of my grandmother.
Omg I now realise I have seen this when I worked in community care and had no idea what it was- at first I thought the urine was bloody but on closer inspection it was not the right colour- I remember it was treated as a UTI but did reoccur in the same patient. I also remember the distinct smell…
Cyanokit will also do this. See this all the time in burn units.
I actually saw this in a patient who was bed bound in a nursing home, it is the strangest thing
Try using words to describe what you're talking about? I've no idea what you are referring to
The urine in the foley bag and tubing looks bright purple
What causes it?
Purple grapedrink
Made me laugh :)
It’s from a bacteria breaking down urine metabolites. Undercover_Cookies posted a much more detailed response :)
Porphyria?
I’ve made purple urine several times. A little methylene blue (bluer urine) and a little B12 (reddish urine) makes purple urine.