An ICU Puzzle: The Red Urine

A 40-year-old man in the ICU develops red urine after being treated for fume inhalation. Explore the Differential Diagnosis for this alarming finding.

Hydroxocobalamin-induced discoloration


A 40-year-old man in the intensive care unit (ICU) was noted to have red urine. Eight hours earlier, he had been found unconscious in a fume-filled car. Cardiopulmonary resuscitation had been initiated for asystole, which resulted in the return of spontaneous circulation. Endotracheal intubation was performed and he received treatment for inhalation of car fumes. Which of the following is the most likely cause of this patient’s red urine?

What is the most likely diagnosis?

Hematuria
Hydroxocobalamin-induced discoloration
Myoglobinuria
Porphyria
Rifampin-induced discoloration

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