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.
- Administration of fluids during surgery.
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