Question on Brown Urine and Taking Today's Warfarin Dose

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ForeverThankful

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I wanted to ask the experienced Warfarin folks here a question. To start, I'm about 6 weeks out from surgery for a mechanical valve and I'm getting weekly testing to stabilize my INR.

Late last night and this morning my urine was dark brown and during the night my gums were bleeding. I should mention that I don't have great gums in general despite having them cleaned every 3 or 6 months so bleeding isn't unheard of but this was quite a bit of bleeding. just for reference I had some bleeding of my gums during the past couple of weeks when my INR levels tested at 3 and 3.8, but none when testing 2.8. Also this is the first time I have seen brown urine.

The brown urine was at about 8am. I drank a couple of glasses of water and then at 11am my urine was a normal yellow color.

I figure the brown urine was caused by my INR being too high but since today is Sunday and the lab is closed and i don't have a home kit I can't get it tested unless I go to an emergency room which I'd rather not do.

I have a call in at my doctor's service and am waiting for a call back but being realistic I don't expect a call anytime soon.

My question is should I take today's dose of Warafin? I take 5mg a day. Tomorrow I'll be going to the lab for my regular INR blood test.

It also occurred to me to take my regular dose and have a leafy green salad to tone it down a bit, does that sound reasonable.

Thanks
Sue
 

LondonAndy

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I would have said your brown urine sounds more like you are a bit dehydrated, and the fact that it returned to straw yellow after drinking some water seems to confirm that. Gums will, of course, bleed longer when INR is higher if they are going to bleed given bad gums, but it doesn't sound like your INR is dramatically out of range if most recent test was 2.8? So yes, I would take your Warfarin, but keep the call in with your doc.

Dehydration is not always obvious - I had a particularly hectic day a few months ago at work, about 10 months after surgery, and went home and all was normal when I went to bed. But I woke up a couple of hours later with my big toe stuck up almost at right angles (and painful!), feeling a bit dizzy and sweaty. After a few minutes I was back to normal, but went off to the emergency department where lots of tests later they concluded it was dehydration. I was on a couple of water tablets (Lasix/Furosemide and Spironolactone), and when I reflected I realised that I had not drunk much during the day.

I remember when I was diagnosed as a type 1 diabetic, about 17 years ago, and something happened soon after that I thought was a result of it. Turned out it was totally unrelated, and my doc said just because I was diabetic didn't mean everything that happens is because of that. But I think we naturally do think things are because of the current thing worrying us.
 

pellicle

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Hi

ForeverThankful;n860724 said:
I wanted to ask the experienced Warfarin folks here a question. To start, I'm about 6 weeks out from surgery for a mechanical valve and I'm getting weekly testing to stabilize my INR.
glad to see you are recovering relatively smoothly from surgery :) Don't worry about your INR taking its time to stabilise, the "safe" range is wide and being in a narrow range is like sports scores ... unimportant next week.

Late last night and this morning my urine was dark brown and during the night my gums were bleeding.
I agree with Andy and feel that the two are probably unrelated. Blood in your urine will be red or pink in colour. Brown indicates you are dehydrated



I was going to mention it but since you bring it up:

I should mention that I don't have great gums in general despite having them cleaned every 3 or 6 months
to me this is a key point of importance and for those of us with BAV and then replacement valves of more importance than the general community. This suggests you have plaque beneath your gum line deeper down on the tooth. This is important to control and you need to look carefully at your dental hygene. Consider flossing daily and do not be ashamed to consult with your dental hygenenist about this. Take it seriously, learn to do it properly (not to damage and to effectively clean).

This is perhaps the #1 point of entry for endocarditis.

bleeding gums is probably 90% caused by plaque and to a lesser extent by vitamin deficiencies.


I figure the brown urine was caused by my INR being too high but since today is Sunday and the lab is closed and i don't have a home kit I can't get it tested unless I go to an emergency room which I'd rather not do.

If I was you I'd invest in the home kit, its simply peace of mind. Who knows, you may end up actually preferring it. I'd get a Coaguchek XS from ebay (I have written heaps about that here).

It also occurred to me to take my regular dose and have a leafy green salad to tone it down a bit, does that sound reasonable.
grab the salad for sure, always taste good. Won't make a scrap of difference to your INR (unless you eat an entire 1kg bag of spinache {thats 2.2 lbs btw}) but munching slowly on salad and looking out the window will be good :)

Best Wishes
 

ForeverThankful

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Hi Andy!

Thanks for your response!

I actually had a lot of liquids last night, so I don't think dehydration is the problem.

Oh and I might not have been clear, my most recent INR this past Monday (6 days ago) was 3.8


I went ahead and took today's dose of Warfarin, hopefully all will go well. I can't wait until this Warfarin dosing settles itself out a bit!
 

ForeverThankful

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Hi Pellicle!

Thanks so much for your response!


Re Dehydration: I really had a whole lot of liquid yesterday and last night.

Re Gums: Thanks for the input, when I say I have my teeth cleaned every 3 to 6 months I mean that I have them deep scaled by my dentist to remove the plague. I also have a prescription rinse that I use everyday as well as flossing. It's always been an issue for me and frankly at this point I'm starting to feel that want to remove these teeth!


Re Home Kit: You are so right, I need to get the kit! I'll be ordering the Coaguchek XS that you recommend.

I would have been fine this morning if I could check my INR level myself. I should mention that I tend to be a tiny bit of a control freak. I like to have access to needed info. And as you said, it brings peace of mind!


Thanks again, I'll be having a salad tonight!

Sue
 

ForeverThankful

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Update:

Took my Warfarin dose at 1pm (3 hrs ago) and just went to the bathroom and my urine is getting darker again. Not as dark as the dark brown it was this morning.

If the urine is dark due to blood from the INR being high then how high would it have to be? Just getting a little nervous here!



Sue
 

pellicle

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Hi

ForeverThankful;n860737 said:
Update:
...If the urine is dark due to blood from the INR being high then how high would it have to be? Just getting a little nervous here!
well from INR alone it may not even cause blood in the urine ... blood in the urine takes a kidney injury. Skigirl here had an INR of nearly 9 with no traces in the urine.

http://www.valvereplacement.org/forums/forum/anti-coagulation/42094-my-monty-python-moment


if its not pink or brilliant red then its not blood. If it persists a simple urine test (pee into a bottle) will isolate just what it is. Your Dr can arrange that.

If its not brilliant red then its minor what ever it is ...

This chart shows results from (iirc thousands of people over some years) an INR clinic on the number of bleed events related to INR. You can see that there is a wide range (which so far you are well within) where there is almost no issue at all



for me knowledge brings confidence and dispels anxiety.
 

W. Carter

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I had quite a few unusual bleeds that seemed they would never stop when I was new to warfarin also. I believe it just takes time for your body to get used to it. Now my inr can be 3.0 to 3.5 (which is in my range) and I can cut my face shaving or my finger cooking and it will stop pretty quick. Give your body a chance to get used to it and you probably won't have any problems. As far as the dark urine, like other comments on here, sounds like it may be dehydration. Try drinking like 4-8 glasses of water and see if that doesn't help. I am on lasix for chf and my urine gets dark too when my body is really dry.
 

ForeverThankful

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pellicle;n860740 said:
If its not brilliant red then its minor what ever it is ...
Cardiologist called me back and he said the same thing! He said if the urine is dark brown then it's either dehydration or a high INR but not anything dangerous. He made a point of saying that the thing to be concerned about is bright red blood.

I have my weekly test tomorrow morning so he said to wait on tomorrow's dose until he gets the results. And he also said to drink a lot of water.



pellicle;n860740 said:
for me knowledge brings confidence and dispels anxiety.
I totally agree and thanks for the chart!

I have so much to learn!
 

ForeverThankful

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Thanks for the response!

W. Carter;n860742 said:
I am on lasix for chf and my urine gets dark too when my body is really dry.
I hadn't even thought of diuretics. I'm on a diuretic (hydrochlorothiazide) for a while after surgery so is it possible that it's causing dehydration even though I'm drinking what seems to be more than enough water?
 

pellicle

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ForeverThankful;n860746 said:
Thanks for the response!
I hadn't even thought of diuretics. I'm on a diuretic (hydrochlorothiazide) f
there is your culprit right there. They are designed to remove fluids from your body

did you have any pericardial effusion? I'm betting that (even if minor) that's why you're on them'

never heard of INR contributing to colouration ... Warfarin isn't cleared by the kidneys either ... so its unlikely to be tainting urine.

:)

best wishes
 

ForeverThankful

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pellicle;n860747 said:
there is your culprit right there. They are designed to remove fluids from your body
What I don't understand is how your urine can turn brown but your hands don't look totally depleted of fluid. But I can now see why I'm drinking plenty of water but still getting dehydrated!

Also, if the diuretic is making you dehydrated then would that mean the dose is too high? Or it isn't needed?


pellicle;n860747 said:
did you have any pericardial effusion? I'm betting that (even if minor) that's why you're on them'
I'm really not sure but I'll bet you're right!

pellicle;n860747 said:
never heard of INR contributing to colouration ... Warfarin isn't cleared by the kidneys either ... so its unlikely to be tainting urine.
I could have misunderstood when he said dehydration and high INR. He might have been thinking the INR could be high because of the gums.
 

pellicle

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Hi

ForeverThankful;n860757 said:
What I don't understand is how your urine can turn brown but your hands don't look totally depleted of fluid. But I can now see why I'm drinking plenty of water but still getting dehydrated!
I dunno for sure, but these things can't just target one area (wish they could) but hit overall. So sometimes this results in a reduction in where you're wanting to reduce (but you'd like it reduced more) but too much from places where you weren't interested in.

I guess like fat .. most of me has little fat, except the two padding handles I have at the back of my waist (as comfort pads for pillion passengers).


I could have misunderstood when he said dehydration and high INR. He might have been thinking the INR could be high because of the gums.
dunno ... coulda been me misunderstanding too :)

Anyway, these are minor bumps along the road to recovery ... happy to help with any of them, glad they are minor.
 

ForeverThankful

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Update:

The initial brown urine was Sunday. Monday morning it looked normal at first and I figured that was the end of this event. Apparently it wasn't the end, mid morning there was bright red blood. Called my Cardiologist who said I should see my family doctor, his guess was a stone or polyp type of thing or even an infection and the Warfarin was just making it bleed more than it should or making it bleed when it wouldn't have bled without the Warfarin.

Saw my doctor on Tuesday, she did a urine test in her office and everything was normal except the blood. She ruled out a few things including infection and then sent me for blood work and a bladder and kidney ultrasound which I got on Wednesday.

She called me today, Thursday, and it seems I have a kidney stone! A relatively large kidney stone!


Just a little bump, or I should say, stone in the road!
 

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