A Fine Specimen in the 'New England Journal' There's a picture in this week's New England Journal of Medicine of a glowing urine-specimen container. Why is it glowing? And how did the picture wind up in one of the world's most prestigious medical journals?
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A Fine Specimen in the 'New England Journal'

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A Fine Specimen in the 'New England Journal'

A Fine Specimen in the 'New England Journal'

A Fine Specimen in the 'New England Journal'

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There's a picture in this week's New England Journal of Medicine of a glowing urine-specimen container. Why is it glowing? And how did the picture wind up in one of the world's most prestigious medical journals?

STEVE INSKEEP, Host:

A picture in today's "New England Journal of Medicine" caught the attention of one of our correspondents. It's a little out of focus but it shows a strange, blue glow coming from a plastic hospital basin.

NPR's science correspondent Joe Palca couldn't miss the chance to investigate.

JOE PALCA: It's always good to have a little esoteric knowledge. For example, Christopher McStay happens to know that there is typically a fluorescent dye in the antifreeze you put in your car's radiator. And he knows why.

CHRISTOPHER MCSTAY: A mechanic could just shine a UV light right on to your radiator at your car and have a look and see where there may be a leak. In other words, the antifreeze will fluoresce.

PALCA: Now, Christopher McStay happens to be an emergency room doctor. He works at Bellevue Hospital in New York City. One morning, an ambulance brought a man into the emergency room. The man appeared to be drunk and was extremely agitated, thrashing about wildly. McStay gave him a sedative and the man calmed down, but he still didn't look well.

MCSTAY: He was breathing very fast. He was also breathing very, very deeply. Each breath that he took was just huge. It was sort of a, huh-ha, huh- ha.

PALCA: Then McStay got a call from the lab. The patient's blood was dangerously acidic. The combination of the convulsive thrashing, the appearance of intoxication, the rapid breathing, and the acidic blood all suggested that it was possible the man had drunk ethylene glycol. And ethylene glycol is extremely toxic.

MCSTAY: One thing about ethylene glycol is that it's very difficult to diagnose at the bedside.

PALCA: So now, McStay's antifreeze expertise comes in handy. Because, you see, ethylene glycol is the main ingredient of antifreeze and antifreeze contains that fluorescent dye. And that gave McStay an idea of how to see if someone had drunk antifreeze.

MCSTAY: It's a very, just sort of, quick and simple test that you can do at the bedside, where you take a sample of urine and just shine a UV light right on to it.

PALCA: So McStay took two kidney shaped plastic basins, put the man's urine in one and some water in the other, shined a UV light on them and took a picture.

MCSTAY: And clearly in the photograph that's in the "New England Journal" here, that I took, is one kidney basin with the patient's urine in it. Which very nicely fluoresces or lights and the other kidney basin was simply water does not.

PALCA: Apparently, in a suicidal moment, the man had drunk antifreeze and it was showing up in his urine.

Now, McStay isn't the first to try this test, and there's even a debate in the medical literature about just how useful a diagnostic test it is. But it does appear to be the first time the "New England Journal of Medicine" has ever published a picture of a glowing urine sample taken from a patient with ethylene glycol poisoning.

Now, is this your first publication in the "New England Journal?"

MCSTAY: Ah, yeah. Yeah.

PALCA: More importantly, McStay's treatment was successful and the patient survived.

Joe Palca, NPR News, Washington.

INSKEEP: This is NPR News.

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