Acute Gout Precipitated by Total Parenteral Nutrition
ROBERT A. MOYER and DOUGLAS ST. JOHN
ABSTRACT.
Hypouricemia is seen in a variety of clinical situations. Although precipitation of gout is well known following initiation of uricosuric therapy, it has been reported rarely following the institution of total parenteral nutrition (TPN), despite its known uricosuric effect. We describe a patient who developed polyarticular gout on 2 occasions after a sudden decline in serum uric acid after initiation of purine-free TPN. Potential etiologies include increased urate clearance due to the infusion of glycine or amino acids. Monitoring of serum uric acid concentrations in patients with a history of gout may help predict a gout attack. Prophylactic treatment or alternative TPN formulations may be indicated. (J Rheumatol 2003;30:849-50)
Key Indexing Terms:
GOUT
PARENTERAL NUTRITION
URIC ACID
HYPOURICEMIA
From the Osteoporosis Center of Dover and Bayhealth Medical Center, Dover, Delaware, USA.
R.A. Moyer, MD, Osteoporosis Center of Dover; D. St. John, PharmD, Bayhealth Medical Center.
Address reprint requests to Dr. R.A. Moyer, Osteoporosis Center of Dover, 720 South Queen Street, Dover, DE 19904.
Submitted July 10, 2002; revision accepted September 12, 2002.
