Symptom: Urine, Tea colored

Initial Grading Reminder

N/A

Assessment and Grading

Characterize the symptom (onset, pace)

Ask the patient:

Have you had issues with your urine being tea colored in the past? Are you taking any new medications or vitamins? Is this a new or worsening symptom? When did it start or get worse? Has it developed gradually or suddenly?

Grade the symptom

Ask the patient:

When did your urine turn tea colored? Are you having any other urination issues?

Patient Query Regarding Other Symptoms/Red Flags

Ask the patient:

Do you have any abdominal (belly) pain? Any nausea or vomiting?  Any swelling? A fever? Are you vomiting? Are you feeling cloudy or confused? Have any muscle aches or weakness?

Patient Factors to Consider That Affect the Approach to Intervention

Consider the following in individualizing the intervention: Is the patient a good or poor historian? Any language barriers or cognitive deficits? Is the patient reliable (able to carry out treatment recommendations)? Does this patient have alcohol/substance abuse issues? Does the patient have transportation? Is there sufficient caregiver support?

  • Click Here for Telephone Triage

    Suggested Intervention

    Patients with other urinary or GI symptoms should be seen.

    Patients with red-flag symptoms should be seen immediately.

  • Click Here for In-Office Triage

    Nursing Assessment of Potential Causes

    Hepatotoxicity - Nursing Assessment

    • Look
    • Listen
    • Recognize
    • Look
    • Listen
    • Recognize
    • Look
    • Listen
    • Recognize
    • Does the patient appear fatigued or listless?
    • Does the patient appear jaundiced?
    • Does the patient appear diaphoretic?
    • Does the patient have any ascites?
    • Change in energy level?
    • Change in skin color? Yellowing?
    • Change in stool color (paler)?
    • Change in urine color (darker/tea colored)?
    • Abdominal pain: specifically, right upper quadrant pain?
    • Bruising or bleeding more easily?
    • Fevers?
    • Change in mental status?
    • Increased sweating?
    • Elevation in LFTs
      • AST/SGOT
      • ALT/SGPT
      • Bilirubin (total/direct)
    • Alteration in GI function
    • Symptoms such as abdominal pain, ascites, somnolence, and jaundice
    • Other potential causes (viral, drug toxicity, disease progression)

    GI Toxicity - Nursing Assessment

    • Look
    • Listen
    • Recognize
    • Look
    • Listen
    • Recognize
    • Look
    • Listen
    • Recognize
    • Does the patient appear weak?
    • Has the patient lost weight?
    • Does the patient appear dehydrated?
    • Does the patient appear in distress?
    • Quantity & quality of bowel movements (e.g., change in/increased frequency over baseline): solid, soft, or liquid diarrhea; dark or bloody stools; or stools that float
    • Fever
    • Abdominal pain or cramping
    • Increased fatigue
    • Upset stomach, nausea, or vomiting
    • Bloating/increased gas
    • Decreased appetite or food aversions
    • Serum chemistry/hematology abnormalities
    • Infectious vs immune-related adverse event causation
    • Peritoneal signs of bowel perforation (i.e., pain, tenderness, bloating)

    Rhabdomyolysis

    Pain, muscle weakness, vomiting, confusion, tea-colored urine

    Differential Diagnosis

    What do you suspect is the cause of tea-colored urine?