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Fluid Changes May Reveal Health Clues

The body tells us how it is functioning through changes in fluid levels: The average person passes 2 to 4 pints of urine per day, depending on their size, age, and the amount of fluid consumed.

The average person passes 1 – 2 liters of urine per day (2-4 pints) obviously depending on size, age and amount of fluid consumed. Passing urine is your body’s way of controlling fluid levels and getting rid of waste products filtered by your kidneys. The normal yellow coloration is due to a substance called urochrome which comes from broken down red blood cells.

I thought it might be interesting to review some of the information one can gather about how your body is functioning from merely checking out urine.

  1. Back in the day, Procol Harum sung of skipping the light fandango and turning cartwheels across the floor in their classic song “A whiter shade of pale.” Such frenetic exercise, however, is likely to turn your urine darker unless you balance the physical endeavors with increased fluid intake. Keeping an eye on urine color is especially important for pilots as dehydration can easily occur in the thin, dry air at altitude or for anyone on a hot day.
  2. Urinary tract infections (UTI), like infections elsewhere, cause inflammation and that in turn can lead to seeing blood in the urine. After seeing red urine, a man should always see a physician, because UTI’s are much more common in women and for a man to have one might indicate a more serious problem.
  3. Another cause of bloody urine is the presence of stones in the kidneys, ureters – the tube leading from the kidney to bladder - or the bladder itself. The blinding pain involved will usually have garnered your attention already!
  4. Cancers in any part of the urinary tract can also present with bleeding into the urine and are often an early sign of trouble brewing.
  5. Benign enlargement of the prostate is a common finding as men age and the stretched blood vessels in the engorged organ can leak some red stuff into the urine.
  6. Sometimes looking like blood, but more often like dark tea (I prefer mine with milk, and only at tea-time) myoglobinuria occurs when muscle tissue has been broken down leading to one of the muscular substances, myoglobin, to leach into the urine. This if seen after trauma or in those abusing various drugs.
  7. Dark tea colored urine can also be caused by antimalarial drugs chloroquine (Aralen), primaquine (generic), and antibiotics like metronidazole (Flagyl) and nitrofurantoin (Furadantin)
  8. Dark brown urine can imply a problem with the liver and the ducts that join it and the pancreas to the gut. Often associated with pale stool, this finding can indicate the presence of stones in the common bile duct, pancreatic cancer or various liver diseases.
  9. In the 1978 book, “Cloudy With a Chance of Meatballs” the residents of Chewandswallow obtained their daily meals from meteorological sources. Cloudy urine is not so appetizing, usually smells unpleasant and is associated with bladder or kidney infections.
  10. You may have heard the term “blue blood” used in connection with royalty; well there is another take on that phrase. King George III was described in British history books as the King who lost America. However, he almost certainly had a rare disease called Porphyria that induces episodes of madness, abdominal pain and blue urine! There are some who think he may, in fact, have had another true mental illness and that his royal blue pee was due to taking gentian, a product obtained from violet flowers.
  11. Certain medicines can also turn urine blue including amitriptyline (generic), indomethacin (Indocin), cimetidine (Tagamet) and promethazine (Phenergan)
  12. An over-the-counter medicine, phenazopyridine can help alleviate burning symptoms from urination and can also turn urine orange.
  13. Propofol, the anesthetic agent implicated in the death of singer Michael Jackson, and a drug named Uribel (similar to phenazopyridine) can turn urine green; I am sure that would get someone’s attention!
  14. Certain hair dyes that contain paraphenylenediamine can render urine black and, of more concern, can damage the kidneys quite severely.
  15. In people who for one reason or another (cancer, surgical necessity or incontinence) need to wear an indwelling catheter, certain bacteria can react with the plastic in these catheters and the urine bag, turning pee into a bright purple color. Known as PUBS (Purple Urine Bag Syndrome) it forever changed the way I perceived the much-loved British drinking establishments!
  16. Everyone knows that asparagus makes urine smell strange (like rotting cabbage) but it does not affect everyone (or not everyone can smell it). Additionally, the urine may get a faint green tinge.
  17. Rhubarb, beetroot and blackberries can turn urine red or pink, but is highly dependent on acid levels in the stomach. Even those people who have this tendency will not always see the color change.
  18. Taking large amounts of B vitamins can give urine a hint of green coloration.
  19. If you smell a “fruity” or “sweet” aroma from urine seek urgent medical attention. It can be a sign of ketones due to diabetes, but of course, if you already know you are a diabetic you will know what to do. It can also come about from lack of food intake either due to excessive dieting or an acute illness. This does merit medical oversight.
  20. I am not partial to soda, but enjoy the bubbles from a glass of champagne. One would not expect to see bubbles in urine and if present they will indicate an abnormal connection between bladder and bowel either due to cancer, diverticulitis, Crohn’s disease or Ulcerative Colitis among others. This is not a cause for celebration so get to a doctor pronto!

So, drink well, pee well, and fly well!

Jonathan Sackier

Dr. Jonathan Sackier is an expert in aviation medical concerns and helps members with their needs through AOPA Pilot Protection Services.

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