Diuretics gout precipitated

Unwanted effects of sulfonamide-type diuretics (a) hypokalemia is a consequence of excessive 1C loss in the terminal segments of the distal tubules where increased amounts of Na are available for exchange with 1C (b) hyperglycemia and glycosuria (c) hyper-uricemia-increase in serum urate levels may precipitate gout in predisposed patients. Sulfonamide diuretics compete with urate for the tubular organic anion secretory system. 

Loop diuretics can cause hyperuricemia and precipitate attacks of gout. This is caused by hypovolemia-associated enhancement of uric acid reabsorption in the proximal tubule. It may be prevented by using lower doses to avoid development of hypovolemia. 

Correct answer = D. Among black patients, diuretic and calcium channel blockers are more effective than ACE inhibitors or p-blockers. Diuretics are effective among the elderly. Thiazide diuretics cause hyperuricemia and can precipitate a gout attack in susceptible individuals. Thiazide diuretics increase LDL cholesterol and may increase the risk of atherosclerosis in patients with hyperlipidemia. Patients with evidence of elevated catecholamines are best treated with p-blockers. Thiazides cannot promote sodium excretion when renal function is severely impaired. The loop diuretics, such as furosemide, are used in patients with impaired renal function. 

He has previously been prescribed bendroflumethiazide on an escalating dose. This in turn precipitated an episode of gout. At this point the thiazide should have been stopped, since thiazide diuretics are contraindicated in gout. This did not happen. 

Thiazide diuretics cause hjrperuricemia and can occasionally precipitate gout (21). They can also cause renal stones (22). Uric acid precipitation is not normally a problem, although it was with the uricosuric drug tieniUc acid. Renal vasculitis due to thiazides is rare (SEDA-18,234). 

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