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Orange Urine

All OK, see updates further below.

...

I write about health at WindInMyFace.com both because it interests me and because it may help someone occassionally, like the nerve damage from Metronidazole I experienced a couple of years ago—a few panicked emails to me showed that some people benefitted, so why not share it and maybe help someone else avoid or reduce negative effects.

Orange urine is not something I’ve experienced before, but coming the day after the dusky-footed woodrat incident and my right abdominal side aching and keeping me awake for hours the past several nights, I couldn’t blame it on an upset stomach another night.

Googling the possible causes or orange urine did not make me feel better, but I don’t think I developed liver disease overnight. It feels like an internal infection, from what I cannot guess, except perhaps not using a water purifier good for bacteria and viruses, and instead using one only good for bacteria (but not viruses), but only a few times and with cold high mountain lake water. Or that damned rat which set up shop near the ventilation air intake but AFAIK only for 14 hours or so. But that seems too quick for a viral infection to develop. Mystery.

I won’t gross out readers with a picture of a pee bottle, but a 1 gallon Crystal Geyser water bottle (scroll down) is a good diagnostic tool for judging improvement from rich Halloween orange to medium yellow (two bottles to compare two time periods). But so far it just seems to be a dilution effect. It is very abnormal (for me at least) to see anything but almost clear after taking in that much fluid (being a double century cyclist, monitoring such things is routine). That water bottle suggestion is only for menfolk of course.

So my liver is under duress, and it feels like an infection in multiple ways. Van living and a bottle gives clues that proper facilities at home would not.

Napping a few hours today seemed to help, at least for a few hours. Drinking about a gallon of fluid today was my working theory in helping the body flush out an infection, so the kidneys are working at least. And my appetite returned after eating minimally for 3 days. Not assuming things will trend the right way, I had blood and urine samples taken at the Northern Inyo Hospital in Bishop CA, just in case things go downhill so that something is known.

Anyway, it’s 7:40 PM and sitting upright is tiring me, so I’ll call it a night. Rotten timing on the new lens.

Update: 19 Oct 16:48

I drove home (6 hours, 280 miles) and will be seeing a physician tonight. Thanks to all the readers who wrote, including some physicians. I’ll post some comments later as time allows. Some points of note:

  • I see no vector for Hepatitis A and I am 99% sure I had the vaccination some years ago. The deadly southern California outbreak of Hepatitis A bears no relation to my circumstances that I can think of, nor do key symptoms match: no lethargy, no fever, no jaundice. I urge most readers to get a Hepatitis A vaccination (see a physician to ask).
  • I slept 13 hours last night, urine still orange in morning, but most of the right abdominal pain was gone. This evening it lingers, but a trace.
  • Lower back discomfort on both sides not a good match for gallstone symptoms from what I understand.
  • After taking in a gallon or so of fluid today, best I can dilute the color down to is medium yellow.
  • Seeing a physician tonight, no word on the blood or urine tests yet.

Update: 19 Oct 19:32

As a light storm moves through, the best weather for photography in 3 weeks, here I am at home, reassured but frustrated at still needing rest and 250 miles from the action. Tioga Pass Rd closed at 5 PM today... I would have position myself right outside there for some fresh-snow photography.

Urine and CBC tests came back normal. The only odd thing (to me) was glucose of 65, and my 14 hour fasting glucose is usually 95. But I hadn’t been eating much for several days due to the discomfort and upset stomach.

Since my appetite returned last night and today OK too, feeling tired (needing sleep) is presumably part of the recovery... never did feel physically weak in that sense of being tired.

Looks like reader George B was on the money in that his idea was/is closest to what my internist mentioned in passing.

George B writes:

Sounds like common duct stone - a gall stone that has exited the gall bladder and is now lodged just before it drains into the duodenum. Might pass but sometimes you need an ERCP where they go into your stomach with scope then into the duct to retrieve the stone. Risk in ignoring it is turning yellow, getting sick, pancreatitis, etc. Ultrasound usually shows the obstruction, dilated blocked duct and maybe the stone itself. If the urine clears to yellow, then likely the stone was small enough to get into the duodenum in which case clear sailing after that. As other conditions can give these symptoms, regardless it needs followup. (I’m a family doctor).

DIGLLOYD: followup done and this most closely matches one of the ideas of what it might have been, according to my internist who mentioned a similar theory of a small blockage, or “colic” in that area. My internist did suggest that if it recurs that I have an ultrasound to determine the problem point.

James G writes:

I'm a physician (full disclosure--a retina surgeon) and your lethargy, lack of appetite and orange urine sound worrisome. Probably a mild to moderate liver issue. I would expect some degree of jaundice with yellowish complexion and a yellow tint to the white of your eyes. Possibly you might not see the jaundice and yellow eyes if the hepatic problem was mild. The differential diagnosis (google medicine.com and type in orange urine or jaundice) includes everything from too many beets for lunch to some really bad juju.

Things like viral hepatitis (most likely hepatitis A), gallstones with inflamed gall bladder, pancreatitis, tumor, G6PD deficiency with something to trigger hemolysis like a drug or fava beans, a drug sensitivity, cirrhosis of the liver, malaria, yellow fever, dengue, etc. Giardia or something else you picked up on your trip would not likely hit you that fast, nor would it be anything you ate unless it had dye or beets or similar in it. And your location in Northern California coupled with your ethnicity as a white guy, presumably no foreign travel, no alcohol abuse and no IV drugs rules out a lot of things.

Your trip to the Bishop hospital for blood work etc was a wise move. You should consider seeing an internist either in Bishop or if you feel well enough, back home in the South Bay/Palo Alto.

... I agree with George B and your internist that a small transient stone in the common duct that has now passed is the most likely diagnosis considering lack of fever, fairly quick onset and improvement, and normal labs. Hopefully you don't have a whole gall bladder full of more of them. An ultrasound should determine that. I hope you recover quickly.

DIGLLOYD: ablood work turned out normal, never did see jaundice. Never made sense to be something nasty given no obvious vector and lack of other symptoms that would accompany something Bad.

Maximilian B writes:

As a GP,at least two diseases come to my mind that would be rat transferable and would need special treatment. One would be Leptospirosis which can start with flu like symptoms,and can cause liver damage in the later stages and importantly has a biphasic course with patients seemingly getting better in between, also hanta virus (and very rarely Arenavirus) infection can cause dark urine via kidney damage. Both have been reported recently in wilderness travelers in california and yosemite. I would ask for confirmation from your doctors those diseases are being / have been ruled out.

DIGLLOYD: did not have flu-like symptoms or any fever and my kidneys happily passed gallons of fluid. Correct that both viruses are present in that area.

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