Dear Colleagues,
We received a urine from a patient admitted at midnight to the emergency ward forming a faint bleu-gray colour after adding
TCA for total protein determination. The patient was admitted after being found in her home. She was found undercooled
laying for several days on the ground with extended decubitus. The exact cause of her situation is not yet clarified.
Known medications are venlafaxine, levomepromazin, risperidone, nordiazepam and alprazolam.
On admission she received Duovent (fenoterolhydrobromide + ipratropiumbromide), gamma-globulins, tetanos vaccination and her
standard medication continued.
We received a urine sample for toxicological and biochemical screening 17 hours after admission.
Screening for protein with dip-stick was posititive for protein and this urine produced a faint blue-gray colour
after adding TCA for total protein. Micro-albumin (turbimetric) was 106 mg/L (positive).
In this sample a very high concentration of venlafaxin and metabolites was found and a trace of levomepromazine.
This contrasts with the (sub)-therapeutic concentration of venlafaxin found in her blood on admission.
Can we attribute the faint blue-gray colour to levomepromazin or to venlafaxin?
Any other suggestions?
Dirk BERNARD, MD
Clinical Chemistry-Toxicology
AZ Sint Jan
Ruddershove 10
B-8000 Brugge
België
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