Urine, dark

ITRACONAZOLE Although rare, die patient may develop hepatitis during itraconazole administration. The nurse closely monitors die patient for signs of hepatitis, including anorexia, abdominal pain, unusual tiredness, jaundice, and dark urine. The primary healtii care provider may order periodic liver function tests. 

The patient is observed for persistent nausea, fatigue, lethargy, anorexia, jaundice, dark urine, pruritus and right upper quadrant tenderness. 

Report adverse reactions such as fluid retention or edema to the extremities weight gain pain, swelling, or tenderness in die legs blurred vision chest pain yellowed skin or eyes dark urine or abnormal vaginal bleeding. 

The variant was found In a 22 year old woman with chronic hemolytic anemia characterized by a persistent retlculocytosls, development of gallstones requiring cholecystectomy, frequent episodes of jaundice, dark urine, and falling PCV value. Her mother, maternal grandfather, and sister have a similar clinical picture In all patients red cell enzymes are elevated with a retlculocytosls of about 10%, and 2,3-DPG levels are normal ... 

Those who have symptoms may experience any of the following flulike symptoms, fevers, fatigue/malaise, anorexia, nausea, vomiting, diarrhea, dark urine, paleappearing stools, pruritus, and abdominal pain. 

Icteric hepatitis is generally accompanied by dark urine, acholic (light-colored) stools, and worsening of systemic symptoms. 

Patients with acute HCV are often asymptomatic and undiagnosed. One-third of adults will experience some mild and nonspecific symptoms, including fatigue, anorexia, weakness, jaundice, abdominal pain, or dark urine. 

Effects reported in humans following dermal exposure to phenol include liver damage, diarrhea, dark urine, and red blood cell destruction. Skin exposure to a relatively small amount of concentrated phenol has resulted in the death of humans. Small amounts of phenol applied to the skin of animals for brief periods can produce blisters and burns on the exposed surface, and spilling dilute phenol solutions on large portions of the body (greater than 25% of the body surface) can result in death. 

Renal Effects. In a case of chronic phenol poisoning, dark urine and glucose in the urine were noted in a man following intermittent exposure to vapors and solutions of phenol (Merliss 1972). The urine tested negative for protein and urobilinogen. The urine cleared 2-3 months after removal from exposure. Although the exposure concentrations were not reported, the study author stated that heavy odors were often detectable, and that phenol was often spilled on the patient s clothes resulting in skin irritation. Since phenol is absorbed readily from the skin, dermal absorption may have contributed to the systemic effects that were observed. 

Renal Effects. Although not adverse, dark urine (as a result of oxidation products of phenol or a result of hemoglobin or its breakdown products in the urine) is a common symptom observed in humans exposed to phenol. In persons exposed to about 0.14-3.4 mg/kg/day phenol in drinking water for several weeks after an accidental spill, dark urine was reported by 17.9% of the most highly-exposed individuals, while only 3.4% of the controls reported the effect (Baker et al. 1978). This difference was not statistically significant. A 3.3-fold increase in the prevalence of dark urine was reported by persons exposed to unspecified doses of phenol after an accidental spill in Korea (Kim et al. 1994). It is not known if the chlorination process, which may have converted a majority of the phenol to chlorophenol, contributed to this effect. 

Renal Effects. Dark urine has been reported in persons occupationally exposed to phenol (inhalation and dermal) (ACGIH 1991 Merliss 1972) and following oral exposure (Baker et al. 1978 Kim et al. 1994). 

It has been stated that the dark urine is a result of oxidation products of phenol (Baker et al. 1978). The dark urine may also be a result of increased hemoglobin in the urine as suggested by the Merliss (1972) case report. In this case it took 2-3 months for the urine to clear after exposure was ended, which is not consistent with pharmacokinetic data that indicate that absorbed phenol is excreted in the urine in 1 day (Piotrowski 1971). A study in rats treated dermally with phenol, which found severe hemoglobinuria and hematin casts in the tubules (Conning and Hayes 1970), suggests that hemoglobin or hemoglobin breakdown products could contribute to the dark urine observed in humans. 

Specific biomarkers used to characterize effects caused by phenol have not been identified. Dark urine has been reported in persons exposed to phenol (orally, dermally, or by inhalation) (ACGIH 1991 Baker et al. 1978 Cronin and Bainer 1949 Kim et al. 1994 Merliss 1972) and following oral exposure. The dark urine may be a result of an oxidation product of phenol or hemoglobin or hemoglobin breakdown products. Further research is required to identify the cause of the dark urine. If it is the result of an oxidation product of phenol, it should be considered a biomarker of exposure. 

Intermediate-Duration Exposure. Adverse effects have been reported following intermediate-duration occupational exposure to phenol (Baj et al. 1994) and intermediate-duration exposure of humans to phenol in the drinking water (Baker et al. 1978 Kim et al. 1994). The effects reported include decreased red blood cell counts (Baj et al. 1994), gastrointestinal effects, dark urine, and direct skin effects (Baker et al. 1978 Kim et al. 1994). 

Chronic-Duration Exposure and Cancer. Mortality was not increased in workers occupationally exposed to phenol (Dosemeci et al. 1991). Effects reported in a case of chronic phenol poisoning, in which exposure was by both the inhalation and dermal routes, included muscle pains in the arms and legs, enlarged and tender liver with increased levels of liver enzymes in the serum, dark urine, and emaciation (Merliss 1972). 

A laboratory technician repeatedly exposed to the vapor (unknown concentration) and to the liquid spilled on the skin developed anorexia, weight loss, weakness, muscle pain, and dark urine. During several months of nonexposure, there was gradual improvement in his condition, but, after brief reexposure, he suffered an immediate worsening of symptoms, with prompt darkening of the urine and tender enlargement of the liver. 

Monitoring At the first symptoms/sign of liver dysfunction (eg, pruritus, dark urine, persistent anorexia, jaundice, right upper quadrant tenderness, unexplained flu-like symptoms) perform laboratory testing. If the patient has laboratory evidence of liver injury of jaundice, stop therapy and do not restart. 

Hepatic Toxicity Hepatic toxicity including hepatic failure resulting in transplantation or death has been reported. Severe and sometimes fatal hepatitis associated with disulfiram therapy may develop even after many months of therapy. Hepatic toxicity has occurred in patients with or without prior history of abnormal liver function. Advise patients to immediately notify their physician of any early symptoms of hepatitis (eg, fatigue, weakness, malaise, anorexia, nausea, vomiting, jaundice, dark urine). 

Hepatic - Pretreatment serum transaminase (ALT and AST) tests are advised for all patients before taking terbinafine. Warn patients to immediately report to their physician any symptoms of persistent nausea, anorexia, fatigue, vomiting, right upper abdominal pain or jaundice, dark urine, or pale stools. Discontinue treatment in patients with these symptoms taking oral terbinafine, and immediately evaluate the patient s liver function. 

Cholestatic hepatitis may occur when drug therapy lasts longer than 10 days or repeated courses are prescribed. The hepatitis is characterized by fever, enlarged and tender liver, hyperbilirubinemia, dark urine, eosinophilia, elevated serum bilirubin, and elevated transaminase levels. Hepatitis has been associated with the estolate salt of erythromycin but not with other formulations. Although the hepatitis usually occurs 10 to 20 days after the initiation of therapy, it can occur within hours in a patient who has had such a reaction in the past. The hepatitis is believed to be the result of both a hepatotoxic effect and a hypersensitivity reaction this latter effect is reversible on withdrawal of the drug. Erythromycin and derivatives induce hepatic microsomal enzymes and interfere with the actions of various drugs, including theophylline and carbamazepine. 

Report signs of bleeding, including black or red stool, coffee-ground emesis, red or dark urine, or red-speckled mucus from cough... 

Nephrotoxicity/hepatotoxicity occurs occasionally, manifested as dark urine/ stools, pain in lower back, jaundice, dysuria, crystalluria, renal colic/calculi. 

Symptoms of overdose may include vomiting, unusual drowsiness, lack of feeling alert, slow or shallow breathing, cold or clammy skin, loss of consciousness, dark urine, stomach pain, and extreme fatigue. 

Notify the physician if abdominal or chest pain, dark urine or light stool, hypoglycemia reactions, fever, nausea, palpitations, rash, vomiting, or yellowing of eyes or... 

Notify the physician if dark urine, pale stool, rash with or without itching, or yellow skin or eyes develops... 

Hepatitis (as evidenced by anorexia, abdominal pain, unusual fatigue orweakness, jaundiced skin or sclera, and dark urine) occurs rarely. 

Report decreased appetite, dark urine, nausea, vomiting, pale stools, unusual fatigue, or yellow skin to the physician... 

Notify the physician if dark urine, cough, generalized fatigue, nausea, pale stools, severe or persistent abdominal pain, shortness of breath, unexplained sore throat or fever, vomiting, or yellowing of the eyes or skin occurs... 

Notify the physician if abdominal pain that lasts longer than 3 days, dark urine, white stools, or yellowing of the sclerae occurs... 

Anorexia, nausea, vomiting, dark urine Occasional... 

Blood draws for LFT monitoring along with routine diabetes mellitus labs. Review symptoms of hepatitis (unexplained nausea, vomiting, abdominal pain, fatigue, anorexia, or dark urine)... 

Notify the physician promptly if dark urine, flu-like symptoms, nausea or vomiting, unusual bleeding or bruising, or any visual disturbances occur... 

Adverse effects include nausea, vomiting, weakness, abdominal pain and methaemoglobinaemia. Haemolytic anaemia in patients with G-6-PD deficiency. Passage of dark urine is indication of haemolysis. In larger dose it can cause leucopenia. 

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