Gout

Gout Sue Renfrow RN, BSN

Gout *A heterogeneous group of conditions related to a genetic defect of purine metabolism resulting in hyperuricemia. Check uric acid levels (know these levels)

Risk Factors *Hyperuricemia *Medication *Diuretics, low-dose aspirin, cyclosporine, nicotinic acid

*Food high in purines (shellfish, organ meats, beer) *Ethanol use *Secondary *Leukemia *Myeloma *Anemia *Psoriasis

Associated Clinical Conditions *Hypertension *Chronic kidney disease *Obesity *Hyperlipdemia; hypertriglyceridemia *Insulin resistance, diabetes mellitus *Cardiovascular disease

Clinical Manifestations *Acute gouty arthritis subsides in 3-10 by itself *Intercritical gout (middle phase) *Chronic tophaceous (little areas that stick out on the side)

Differential Diagnosis *MSU crystals in synovial fluid *Fever, leucocytosis & elevated ESR *X-Rays show soft tissue swelling

Medical Management *Acute

*Colchicine (administer at onset of symptoms), NSAIDs, glucocorticoids

*Intercritical- breaks out in between acute and chronic times *Colchicine, NSAIDs

*Chronic *Uricosuric agents (allopurinol-lowers blood uric acid levels-worry about kidneys-kidney stone) KNOW THESE MEDS p.1631

Nursing Management *Encourage healthy diet *Weight loss *Pain management *Educate (limit alcohol consumption)