Turner White CommunicationsAbout TWCSubscribeContact TWCHomeSearch
Hospital PhysicianJCOMSMPBRMsCart
Current Contents
Past Issue Archives
Interactive:
Self-Assessment Questions
Review of
Clinical Signs
Clinical Review
Quiz
Pediatric Rounds
Resident Grand Rounds
Article Archives
Case Reports
Clinical Practice
Exams
Pediatric Rounds
Resident Grand Rounds
Review of
Clinical Signs

Guide to Reading
Hospital Physician
Editorial Board
Information for Authors

Reprints, Permissions, & Copyright
Site Map
Self-Assessment Questions

Rheumatology


Answer 6
  1. Administration of fluids during surgery. Any condition that results in a fluctuation of uric acid can precipitate a gout attack. Fluid administration during surgery can quickly lower the uric acid level; the typical time course to development of a swollen joint is 2 to 3 days. Medications that increase uric acid levels as a result of volume contraction (eg, diuretics) or inhibit uric acid secretion (eg, cyclosporine) can also cause gout. The change in fluid distribution during bed rest is also a factor in precipitating gout and accounts for the classic presentation of waking from sleep with a painful joint; however, immobilization itself is not a precipitating factor. Estrogen therapy increases uric acid secretion and thus has a protective effect on the risk of developing gout. Cold temperatures can lower the solubility of uric acid in body fluids, increasing the frequency of distal joint gout attacks; warm temperatures have no known effect.

Click here to return to the questions

 

Hospital Physician     JCOM     Seminars in Medical Practice
Hospital Physician Board Review Manuals
About TWC    Subscribe    Contact TWC    Home    Search   Site Map

Copyright © 2009, Turner White Communications
Updated 1/04/08 • kkj