Phenytoin-Induced Red Discoloration of Urine in a Pediatric Neurosurgical Patient: An Unusual Finding

Abstract

The use of phenytoin is widespread in neurosurgical patients, especially in space-occupying lesions. It has pre-dominant renal excretion and has been known to cause tubulointerstitial nephritis on chronic use. Despite its com-mon use, there has not been de fi nitive literature on urine discoloration due to phenytoin except for a commentary dated back in 1983 which refuted the fi nding of urine discoloration by phenytoin use. 1 Hence, we intend to high-light a case where there was episode of red discoloration of urine in a pediatric patient posted for excision of the cerebellar tumor under general anesthesia. A 9-year-old female, weighing 30kg, presented to the neurosurgical department with complaints of headache and vomiting for 1 month. On examination, her Glasgow Coma Scale was E4V5M6 with no neurological de fi cit, left side cerebellar signs were positive, including dysdiadokine-sia and fi nger nose test. Contrast-enhanced magnetic resonance imaging revealed a 3 (cid:1) 3.5 (cid:1) 4cm lesion in the left cerebellar hemisphere with mild hydrocephalus ( ► Fig. 1 ). She was started on tablet levetiracetam 300mg twice daily, syrup glycerol three tablespoons four times a day, and tablet acetazolamide 250 mg twice daily. She was posted