Uric Acid fluid

Diuretics are one of the dmg categories most frequendy prescribed. The principal uses of diuretics are for the treatment of hypertension, congestive heart failure, and mobilization of edema fluid in renal failure, fiver cirrhosis, and ascites. Other applications include the treatment of glaucoma and hypercalcemia, as well as the alkafinization of urine to prevent cystine and uric acid kidney stones. 

T. Seki, K. Yamaji, Y. Orita, S. Moriguchi and A. Sliinoda, Simultaneous determination of uric acid and creatinine in biological fluids by column-switching liquid cliromatogra-phy with ulti aviolet detection , 7. Chromatogr. A 730 139-145 (1996). 

DRUGS USED FOR GOUT. The nurse encourages a liberal fluid intake and measures the intake and output. The daily urine output should be at least 2 liters. An increase in urinary output is necessary to excrete the urates (uric acid) and prevent urate acid stone formation in the genitourinary tract. 

Grootveld, M. and Halliwell, B. (1987). Measurement of allan-toin and uric acid in human body fluids. A potential index of free radical reactions in vivo Biochem. J. 243, 803-808. 

All patients with major patterns are monitored for rhabdomyolysis and renal failure. An early sign of rhabdomyolysis is an elevated serum uric acid, associated with an increase in serum CK. Within 8 to 12 hours, the serum tests are repeated. If the uric acid falls and the CK rises, rhabdomyolysis is likely. Renal function tests may also be increased at this time. When the diagnosis of rhabdomyolysis is made, the patient is treated with 40 mg furose-mide IV once, and IV fluids. Urine myoglobin concentrations are obtained. If the patient develops renal failure, hemodialysis or peritoneal dialysis may be necessary. In all cases, multiple drug intoxication, trauma, and rhabdomyolysis are ruled out or treated. All patients are kept under observation until they are asymptomatic. 

Allopurinol is well absorbed with a short half-life of 2 to 3 hours. The half-life of oxypurinol approaches 24 hours, allowing allopurinol to be dosed once daily. Oxypurinol is cleared primarily renally and can accumulate in patients with reduced kidney function. Allopurinol should not be started during an acute gout attack because sudden shifts in serum uric acid levels may precipitate or exacerbate gouty arthritis. Rapid shifts in serum uric acid can change the concentration of monosodium urate crystals in synovial fluid, causing more crystals to precipitate. Thus some clinicians advocate a prophylactic dose of colchicine (0.6 mg/day) during initiation of antihyperuricemic therapy. Acute episodes should be treated appropriately before maintenance treatment is started. 

Although generally well tolerated, probenecid can cause gastrointestinal side effects such as nausea and other adverse reactions, including fever, rash, and rarely, hepatic toxicity. Patients should be instructed to maintain an adequate fluid intake and urine output to decrease the risk of uric acid stone formation. Some experts advocate alkalinizing the urine to decrease this risk. 

The term gout describes a disease spectrum including hyperuricemia, recurrent attacks of acute arthritis associated with monosodium urate crystals in leukocytes found in synovial fluid, deposits of monosodium urate crystals in tissues (tophi), interstitial renal disease, and uric acid nephrolithiasis. 

Coupled enzyme assays have been developed for the determination of substances as diverse as glucose, uric acid, and cholesterol, the principal application being quantitation in biological fluids such as blood, plasma, and urine. Typical examples are illustrated by Eqs. (9)-(12). 

Urinary alkalinization- Urates tend to crystallize out of an acid urine therefore, a liberal fluid intake is recommended, as well as sufficient sodium bicarbonate (3 to 7.5 g/day) or potassium citrate (7.5 g/day) to maintain an alkaline urine continue alkalization until the serum uric acid level returns to normal limits and tophaceous deposits disappear. Thereafter, urinary alkalization and the restriction of purine-producing foods may be relaxed. 

Organic acid secretory systems are located in the middle third of the straight part of the proximal tubule (S2 segment). These systems secrete a variety of organic acids (uric acid, nonsteroidal anti-inflammatory drugs [NSAIDs], diuretics, antibiotics, etc) into the luminal fluid from the blood. These systems thus help deliver diuretics to the luminal side of the tubule, where most of them act. Organic base secretory systems (creatinine, choline, etc) are also present, in the early (Si) and middle (S2) segments of the proximal tubule. 

Uses Acute chronic gout Action X Renal tubular absorption of uric acid Dose 100-200 mg PO bid for 1 wk, T PRN to maint of 200—400 mg bid max 800 mg/d take w/ food or antacids plenty of fluids avoid salicylates Caution [C (D if near term), /-] Contra Renal impair, avoid salicylates peptic ulcer blood dyscrasias, near term PRG, allergy Disp Tabs, caps SE N/V, stomach pain, urolithiasis, leukopenia Interactions T Effects OF oral anticoagulants, oral hypoglycemics, MTX X effects W/ ASA, cholestyramine, niacin, salicylates, EtOH X effects OF acetaminophen, theophylline, verapamil EMS T Effects of anticoagulants and oral hypoglycemic X effects of verapamil OD May cause N/V, loss of coordination, dyspnea, Szs symptomatic and supportive... 

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