CASE PRESENTATION ON GOUT AND HYPERURICEMIA

1. CASE PRESENTATION
ON GOUT AND
HYPERURICEMIA

2. SUBJECTIVE
PATIENT NAME : Mr. M
AGE : 66
SEX : Male
CURRENT PROBLEM :
• Severe angle pain
• Inflammation of angle
PAST MEDICAL HISTORY :
• Dyslipidemia
PAST MEDICATION HISTORY :
• Atorvastatin 20mg PO BD since last 2 months
• Loratidine 10mg PO OD

3. OBJECTIVE
PHYSICAL EXAMINATION :
conscious, oriented, afebrile
VITAL SIGNS :
VITAL SIGNS DAY 1 DAY 2 DAY 3
Temp ˚ F 98.4 98.4 98.4
BP ( mm/Hg ) 136 / 88 130 / 90 120 / 80
PR / min 82 80 82
RR / min 18 20 20

4. OBJECTIVE
LABORATORY INVESTIGATION
CONSTITUENTS DETECTED VALUE NORMAL VALUE
COMPLETE BLOOD COUNT
ESR 22 3 – 10 mm
WBC 18,710 4,000 – 11,000cells/cumm
BIOCHEMISTRY
HDL 25 > 40 mg /dl
Triglyceride 280 < 150 mg / dl
Uric acid 11.6 2 – 7 mg / dl

5. OBJECTIVE
SPECIALISED TEST :
(A) X Ray OF ANGLE :
Negative for break or damage
(B) ASPIRATION FLUID FROM ANGLE JOINTTAP :
>50WBC/HPF containing negativity birefringent monosodium
urate crystals ( 0 – 5WBC/HPF )

6. DIAGNOSIS
GOUT AND HYPERURICEMIA

7. ASSESSMENT
Sl . No `DRUGS PRESCRIBED DOSE FREQ ROA DAY 1 DAY 2 DAY 3
BRAND NAME GENERIC NAME
1 T. Uloric Febuxostat 40 mg OD PO
2 T. Mobic Meloxicam 15 mg OD PO
3 T. Microzide Hydrochlorthiazide 25mg QDS PO
4 T. Lipitor Atorvastatin 20 mg BD PO
5 T. Claritine Loratidine 10 mg TDS PO

8. TREATMENT PROGREESION
DAY 1 :
Patient came up with severe angle pain and abnormal vitals. Blood sample is
collected for the lipid profile test. Patient continued with his own drug.
DAY 2 :
Angle pain tend to reduce, patient undergone X Ray investigation and aspiration fluid
collected from angle.Vitals tends to be stable.
DAY 3 :
Patient with slightly reduced angle pain. Inflammation also started to reduce. Patient
feeling comfort and with stable vitals. He got discharged

9. TREATMENT INDICATION
FEBUXOSTAT :
• Non purine selective inhibitor of xanthine oxidase
• Used to reduce the level of uric acid in our body
• It blocks the site of xanthine oxidase which converts both hypoxanthine and
xanthine to uric acid
MELOXICAM :
• NSAID drug
• Used to treat pain and inflammation
• It works by blocking the enzymes responsible for making prostaglandins,
compound that contribute mainly joint inflammation

10. TREATMENT INDICATION
HYDROCHLORTHIAZIDE :
• Diuretic drug
• Used to treat hypertension, edema
• It affects renal tubular mechanism of electrolytes reabsorption resulting in
an increase in the excretion of sodium and chloride
ATORVASTATIN :
• Statin drug
• Used as lipid lowering agent
• It inhibits HMG CoA reductase enzyme which converts mevalonate into
cholesterol

11. TREATMENT INDICATION
LORATIDINE :
• Tricyclic antihistamine drug
• Used to treat itching, running nose, sneezing etc
• It acts as a selective increase agonist of peripheral histamine H1 receptors

12. PHARMACIST INTERVENTION
• HYDROCHLORTHIAZIDE + MELOXICAM :
Intake of both these drugs decreases the diuretic and hypertensive efficacy
•Hydrochlorthiazide with the adverse drug reaction of
hyperuricemia should not be prescribed to the patient and could be
substituted with any other diuretics

13. PATIENT COUNSELLING
DISEASE BAED :
• Cut out stress in life
• Exercise frequently
• Get enough rest and sleep
• Check uric acid level twice a year
• Stay hydrated
DIET BASED:
• Limit the alcohol as it increases uric acid level in body
• Intake of Food rich in purines such as fatty meats sand shell fish
• Increase intake of coffee, cherries and foods rich in vitamin c
• Try certain herbal and dietary supplpements

14. THANKYOU