Skip to Main Content

Instructors can request access to the Casebook Instructor's Guide on AccessPharmacy. Email User Services (userservices@mhprofessional.com) for more information.

LEARNING OBJECTIVES

After completing this case study, the reader should be able to:

  • Identify major risk factors for developing gout in a given patient, including drugs that may contribute to or cause this disorder.

  • Develop a pharmacotherapeutic plan for a patient with acute gouty arthritis that includes individualized drug selection and assessment of the treatment for efficacy or toxicity.

  • Identify patients in whom maintenance therapy for gout and hyperuricemia is warranted.

  • Identify medications not used primarily for gout that may have a beneficial effect on serum uric acid (SUA) levels.

PATIENT PRESENTATION

Chief Complaint

“My toe is on fire.”

HPI

Roy Huff is a 78-year-old man who presents to the ED complaining of significant toe pain. Mr Huff states, “I think I’m paying the price for my fun at Oktoberfest.” He reports having spent the weekend indulging on beer and sausage at the local Oktoberfest festival. In the early hours of Monday morning (approximately 3 hours ago), he awoke to sudden excruciating pain in his right big toe. Over the past hour, this toe has become red, swollen, and so painful that he cannot walk. He has not experienced any trauma or injuries. He also denies having experienced these symptoms previously.

PMH

  • HTN

  • PUD

  • Obesity

SH

The patient typically drinks “a can of beer or two” daily but drank significantly on Friday, Saturday, and Sunday. He does not smoke or use illicit drugs.

Meds

  • Chlorthalidone 25 mg PO daily, started 1 month ago

  • Omeprazole 20 mg PO daily

All

NKDA

ROS

Other than feeling somewhat dehydrated from all of his drinking, the patient has no major complaints prior to this ED visit. No chest pain, nausea/vomiting, or respiratory symptoms. Bowel habits are normal. He has no prior history of arthritic symptoms or joint problems.

Physical Examination

Gen

A healthy-appearing, obese, white man in acute distress

VS

BP 120/60 mm Hg, P 110 bpm, RR 19, T 37.5°C; Wt 88 kg, Ht 5′6″

Skin

Poor skin turgor. No rashes or other dermatologic abnormalities.

HEENT

PERRLA, dry mucous membranes, throat/ears clear of redness or inflammation

Neck/Lymph Nodes

Negative for lymph node swelling or masses

Lungs/Thorax

Clear to auscultation bilaterally, symmetric movement with inspiration

CV

...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.