Acute gout precipitated by total parenteral nutrition.
Hypouricemia is seen in a variety of clinical situations. Although precipitation of gout is well known following initiation of uricosuric therapy, it has been reported rarely following the institution of total parenteral nutrition (TPN), despite its known uricosuric effect. We describe a patient who developed polyarticular gout on 2 occasions after a sudden decline in serum uric acid after initiation of purine-free TPN. Potential etiologies include increased urate clearance due to the infusion of glycine or amino acids. Monitoring of serum uric acid concentrations in patients with a history of gout may help predict a gout attack. Prophylactic treatment or alternative TPN formulations may be indicated.
Moyer
Robert A
RA
Osteoporosis Center of Dover, Delaware 19904, USA.
John
Douglas St
DS
D000208:Acute Disease; D000230:Adenocarcinoma / Q000601:surgery; D016629:Esophagectomy; D005743:Gastrectomy; D005770:Gastrointestinal Neoplasms / Q000601:surgery; D006073:Gout / Q000097:blood / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010289:Parenteral Nutrition, Total / Q000009:adverse effects*; D014527:Uric Acid / Q000097:blood / Q000493:pharmacokinetics
D014527:Uric Acid