Creatinine–1.8 mg/dl
Comment on report.Ans: The presented reports show increased uric acid levels in serum. High uric
acid levels indicate gout. In gout, uric acid is deposited in joints leading to
inflammation and pain. Here, increased uric acid in serum does not correlate
with normal creatinine; hence possibility of kidney dysfunction is ruled out.
Q.2. A 1-year-old baby having retarded development and showing habits of lips
andfinger biting was brought to hospital. The laboratory investigation of
blood sample revealed very high uric acid levels (9.5 mg/dl), while hemo-
globin, urea, creatinine, and sugar were within normal range. Comment on
the report.
Ans: The clinical features of delayed development and high serum uric acid levels
are suggestive of Lesch-Nyhan syndrome. In this syndrome, the deficiency
of theenzyme hypoxanthine-guanine phosphoribosyltransferasecauses high
uric acidlevels in bodyfluids. The combination of increased synthesis and
decreased utilization of purines leads to high uric acid levels, a condition
calledhyperuricemia.
Q.3. A 45-year-old man was complaining of severe pain in the right toe. He did
not reveal any history of pain in any joints previously. He had been binge
drinking the previous night. On examination, he had fever and was in
distress due to the pain. The right toe was swollen, warm, red, and very
tender. Synovial fluid analysis revealed needle-shaped crystals under
microscopy. Serum uric acid level was 8.9 mg/dl, and 24 hr urinary uric
acid excretion was 500 mg/dl. Random blood sugar was 140 mg/dl. Other
tests were normal. What is the likely diagnosis?
Ans: The likely diagnosis is gouty arthritis. The pain in the big toe is precipitated
by alcohol intake, which is a typical feature of gouty arthritis. Serum uric
acid and synovial fluid analysis results are confirmatory. Gout is
characterized by hyperuricemia. Monosodium urate crystals are deposited
in joints and connective tissues, and there is risk of uric acid nephrolithiasis.
Acute gouty arthritis can be triggered by trauma, stress, vascular occlusions,
surgery, drugs, and purine-rich food including alcohol. Hyperuricemia can
be due to increased production or reduced excretion of uric acid or a
combination of these two.
Q.4. A 40-year-old male consumed much food and alcohol during dinner. The
next morning, he felt excruciating pain in the ankle. On examination, he had
fever. His ankle joint was red and swollen and was very tender and stiff. No
other joints were involved. Lymph glands were normal. The laboratory data
was:
Blood glucose: 120 mg/dl
Blood urea: 40 mg/dl
Serum creatinine: 1.2 mg/dl
Serum uric acid: 10.5 mg/dl39.5 Case Studies of Gout/Uric Acid 161