CASE PRESENTATION ON

GOUT
PRESENTED BY:-
K . Meena Sri
619167102011
PATIENT’S DEMOGRAPHIC DETAILS

NAME:- Nathan Vance

AGE:- 66 years
GENDER:- Male
WEIGHT:- 97 Kgs
HEIGHT:- 5’11”
C/O:- Sudden onset of pain in his left ankle
red and swollen ankle
hot flushes after taking niacin
Past Medical History:- Dyslipidemia
Peptic Ulcer Disease
Duodenal Ulcer( 6 months ago)
Obesity
Social History:- one or two can of beer daily
non smoker
Medication History:- Niacin-1 gm p.o. at bedtime since 2 months
Omeprazole- 20mg p.o. daily
Simvastatin and atorvastatin d/c due to muscle aches
 PHYSICAL EXAMINATION
GEN:-Healthy appearing obese, white male in acute distress
V.S.:- B.P.= 135/88 mmHg
Pulse rate= 100 bpm
R.R.= 18
Temp.= 37.5
SKIN:- No rashes or other dermatological abnormalities. Has “skull” tattoo on his left arm
HENT:- PERRLA, throat/ears clear of redness/inflammation
Neck/Lymph nodes:- negative for swelling or masses
Lung/Thorax:- clear to auscultation
CV:- RRR, normal S1 and S2
Abd:- obese, but soft, non-tender, positive bowel sounds in all quadrants
Genital/Rectal:- deferred
MS/EXT:- left ankle 3+ edema around joint
contrasted erythema present warm to touch
painful 10/10 ( on scale of 1-10)
no swelling or any other joint including great toe
no signs of trophi present
Neuro:- (A & O)3
CN II-XII grossly intact
no focal neurological deficits
PARAMETERS LAB VALUE REFERENCE VALUE
Na 138 mEq/L 135-145 mEq/L
K 3.9 mEq/L 3.6-5.2 mEq/L
Cl 101 mEq/L 96-106 mEq/L
CO2 23 mEq/L 23-29 mEq/L
BUN 9 mg/dl 7-20 mg/dl
Serum Creatinine 1.0 mg/dl 0.7-1.35 mg/dl
Glucose 105 mg/dl less than 140 mg/dl
Uric acid 11.6 mg/dl 4-8.5 mg/dl
Haemoglobin 15.1 g/dl 13-17 g/dl
Haematocrit 45% 41-50 %
RBCs 4.9 lakh/mm3 4.7-6.1 lakh/mm3
Platelets 2 lakh/mm3 1.5-4.5 lakh/mm3
MCV 81 micrometer3 80-100 micrometer3
MCHC 35 g/dl 33.4-35.5g/dl
ESR 45 mm/h 0-20 mm/h
WBCs 12800/mm3 4000-11000/mm3
Neutrophils 88% 40-75%
Basophils 0% 0.5-1%
Eosinophils 1% 0-6%
Lymphocytes 10% 20-45%
Monocytes 1% 0-10%
RF negative -
HDL-C 25 mg/dl more than 60mg/dl
TG 280 mg/dl < 150 mg/dl
LDL-C 99 mg/dl < 100 mg/dl
Total Cholestrol 180 mg/dl < 200 mg/dl
Ankle radiograph:- Negative for
break/damage
Aspirate fluid from ankle joint tap:- 750
WBCs/HPF, containing negatively
birefringent monosodium urate crystals
DIAGNOSIS: From subjective and objective
evidences,it was diagnosed as GOUT
 TREATMENT CHART

DRUG NAME DOSE FREQUENCY ROUTE INDICATION

1 mg initially, Until the symptoms
followed by 0.5mg subside or a total 8mg With food
Tab. COLCHICINE every 2 hrs has been administered orally d/c after 7 days

Tab. EZETIMIBE 10 mg 1-0-0 orally With or without food

Tab. FUROSEMIDE 20 mg 0-1-0 orally With food

Tab. Empty stomach or 1
OMEPRAZOLE 20 mg 1-0-0 orally hour before meal
 GOALS OF TREATMENT

• Relive pain and inflammation

• To terminate the acute attack, prevent recurrent attacks of gouty arthritis
• To prevent complications associated with chronic deposition of urate crystals
• Maintain patient’s normal life style
• To bring cholesterol levels to normal
• To avoid increased cholesterol related complication
• To reduce cardiovascular risk
 PHARMACIST INTERVENTION
• Simvastatin and atorvastatin prescribed in combination can be a cause of
severe myalgia observed in patient.
 MONITORING PARAMETERS
COLCHICINE:- Complete blood count
Renal function test
Liver function test
EZETIMIBE:- Liver enzymes
FUROSEMIDE:- Serum Creatinine
Kidney function test
OMEPRAZOLE:- Electrolytes
Urea levels
 TREATMENT OPTIONS

• If GI abnormalities or bone marrow toxicity

observed switch to corticosteroids.
• If needed add tab. Orlistat- 120 mg orally with
meal for obesity
 PATIENT COUNSELLING
DISEASE REALTED:-
Gout:- A form of arthritis due to accumulation of uric acid crystals in joints. It’s common
symptoms are joint pain, redness, swelling. It can lead to joint damage or deformity.
Peptic Ulcer:- It is inflammation of the lining of GI tract. It’s common symptoms include
abdominal pain which worsens after meals, nausea, vomiting, bleeding in stools.
Dyslipidemia:- It is abnormal levels of cholesterol levels in blood and it can lead to clogged
arteries and heart attack.
Obesity:- Excessive body fat that may increase the risk of cardiovascular and endocrine
disorders.
DRUG RELATED:-
COLCHICINE:- This drug is given for gout. You have to take 1mg first and then 0.5mg
every 2 hours until the symptoms are subsided. It is to be discontinued after 7 days due to
risk of bone marrow toxicity. It’s common ADR are abdominal pain, headache, rash.
EZETIMIBE:- This drug is given for dyslipidemia to bring cholesterol levels to normal. It is
to be taken in the morning with or without food. It’s common ADR are fatigue, abdominal
pain, headache.
FUROSEMIDE:- This drug is given to treat edema and it is to be taken for short time. It
should be taken after lunch. It’s common ADR are dizziness, constipation, vertigo.
OMEPRAZOLE:- This drug is for peptic ulcer. It should be taken on empty stomach or 1
hour before meal in the morning. It’s common ADR are diarrhoea, abdominal pain,
flatulence.
LIFESTYLE MODIFICATION:-
• Vigorous aerobic excersice needed like jogging and cycling for atleast 30
mins.
• Moderate consumption of fatty foods containing oil, butter, ghee and
meats high in purine.
• Moderate consumption of carbohydrate rich foods like wheat, potatoes,
bananas.
• Less consumption of dairy products like cheese, desserts, creams.
• Increase fibre rich foods like fruits, beans, carrots.
• Engage in yoga and meditation programme.
• Get proper sleep atleast for 8 hours.
THANK YOU!