A 47-year old man presents with severe pain in his right great toe. He is unable to bear weight on his right foot and there was no apparent trauma. He reports the pain started last night and continued to increase in severity. Based on his physical exam and laboratory findings he is diagnosed with gout. Gout can be caused by several different mechanisms and blood samples are drawn and urinalysis is performed. The results from this individual are listed below. Plasma Urate(mg/100 ml) Urinary Uric Acid(mg/24 hr)
Normal < 7.0 413 ± 78
Patient 10.5 215

What is the best explanation for the presentation of gout in this individual and please explain why the other choices are not consistent with the data or what additional information you may need to decide the root cause?

1. Overproduction of purines
2. Decreased salvage of purines
3. Decreased urinary excretion of uric acid

After further discussion with the patient, he tells you that he recently switched from diet soda to regular soda because he read that the 'fake sugar' diet soda was bad for him; he tells you he drinks between 4and 5 L of soda a day. What is the potential impact of this dietary modification on the presentation of gout?

As, this individual is expending fructose syrup.  

Fructose is changed over to purine which is additionally changed over to uric acid.  

Along these lines, more fructose in the eating routine then more purines in the body which will additionally frame progressively uric acid.  

This uric acid gathers and causes gout.  

What is the best clarification for the introduction of gout right now please clarify why different decisions are not reliable with the information or what extra data you may need to choose the underlying driver?  

1. overproduction of purines-They are not being created in the body however yes they are certainly are delivered from the abundance fructose expended.  

2. diminished rescue of purines-No, this isn't the main driver.  

3. diminished urinary discharge of uric acid this can occur as less uric acid is being discharged in the pee.  

When, contrasted with the ordinary individual the patient is discharging less uric acid.  

Along these lines, third point is the purpose behind gathering of uric acid in the body.

answer: tell your parents first, and wait another couple of days. if it gets any worse, then you should call and ask. and you can always take pain meds if need be.

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