Acute Gout Case Studies

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Gout is a “disorder of metabolism that allows uric acid or urate to accumulated in the blood and tissues”(Rothschild, 2015, p. 3). It is more common in men than in women and has a higher incidence in 70 to 79 years of age. The gout syndrome is “ caused by alteration in purine metabolism, the end product which is uric acid. This results in hyperurecemia and in the deposition of urate crystals in various tissues (Woo & Wynne, 2011, p. 869). Hyperuricemia can occur due three mechanisms:
1. Decreased excretion (underexcretors): Accounts for most cases and occurs when altered uric acid excretion results from decreased glomerular filtration (can contribute to the hyperurecemia of renal insufficiency), decreased tubular secretion (seen in patients
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A gout attack is characterized by the presence of urate crystals in the soft tissues and synovial tissue and is often precipitated by sudden increase, or sudden decrease in serum urate levels. Symptoms of acute gout are the “sudden onset of pain, erythema, limited range of motion, and swelling in the involved joint, usually involving the first metatarsal joint of the great toe”(Woo & Wynne, 2011, p. 869). Acute gout can be observed in four stages:
1. Asymptomatic Hyperuricemia: Occurs without obvious symptoms but hyperuriecemia and the asymptomatic deposition of crystals are present in the tissues, causing damage.
2. Acute Gouty Arthritis: Usually involves a single joint (most often in the lower extremities such as the metatarsophageal joint of the great toe or knee), when urate crystals cause acute inflammation. Characterized by pain, redness, swelling, and warmth lasting for days or weeks with mild or excruciating
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3). Naproxen is a safer medication in regards to cardiovascular side effects and NSAIDs are recommended for patients with no history of kidney or liver disease, no bleeding problems, who do not use anticoagulant agents, and no history of stomach or duodenal ulcer. It is most effective when started as early as possible and at higher doses, when treating a gout attack. Adverse effects include GI upset or bleeding, hyperkalemia, increases in creatinine, and fluid

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