Case 17: Gout A 61-year-old member of a medical faculty was awarded an honorary degree 4 days before admission to the ho
Posted: Mon Nov 15, 2021 4:45 pm
Case 17: Gout
A 61-year-old member of a medical faculty was awarded an
honorary degree 4 days before admission to the hospital. Following
the ceremony, he spent the evening with friends where, as he put
it, the “conviviality flowed extensively.” The next morning he
noticed a dull pain in the left flank, which worsened until
hospitalization was
required. Physical examination revealed no overt signs of
disease. A urine sample obtained on admission had a pH of 4.5 and
was +ve for protein. Microscopic examination of the centrifugal
sediment from the sample revealed fine crystalline material and
numerous casts. A 24-hr urine sample contained 115mg/dl of protein
and 1.52 (9 mmol) of uric acid. The serum uric acid content was
11.8mg/dl (0.70mmol/L); normal is 3.5 to 7 mg/dl (0.2 to 0.4
mmol/L).
Answer the following questions:
1. Could useful information be obtained from a family history of
gout? Explain.
2. Are purines and pyrimidines required in the diet?
Explain.
3. What foods are high in purines and pyrimidines?
4. Would you expect a diet high in protein to be harmful to this
patient? Explain.
5. What is the ionic form of uric acid in this patient’s urine?
What is its solubility?
6. What is the biochemical basis for the action of drugs used in
the treatment of gout?
A 61-year-old member of a medical faculty was awarded an
honorary degree 4 days before admission to the hospital. Following
the ceremony, he spent the evening with friends where, as he put
it, the “conviviality flowed extensively.” The next morning he
noticed a dull pain in the left flank, which worsened until
hospitalization was
required. Physical examination revealed no overt signs of
disease. A urine sample obtained on admission had a pH of 4.5 and
was +ve for protein. Microscopic examination of the centrifugal
sediment from the sample revealed fine crystalline material and
numerous casts. A 24-hr urine sample contained 115mg/dl of protein
and 1.52 (9 mmol) of uric acid. The serum uric acid content was
11.8mg/dl (0.70mmol/L); normal is 3.5 to 7 mg/dl (0.2 to 0.4
mmol/L).
Answer the following questions:
1. Could useful information be obtained from a family history of
gout? Explain.
2. Are purines and pyrimidines required in the diet?
Explain.
3. What foods are high in purines and pyrimidines?
4. Would you expect a diet high in protein to be harmful to this
patient? Explain.
5. What is the ionic form of uric acid in this patient’s urine?
What is its solubility?
6. What is the biochemical basis for the action of drugs used in
the treatment of gout?