Rx Note

Introduction Gout is a common form of inflammatory arthritis characterised by raised uric acid concentration in the blood (hyperuricemia) and the deposition of urate crystals in joints and other tissues. Risk Factors Men Elderly - rare in children and pre- menopause women. Obesity Hypertension High consumption of alcohol (particularly beer and spirits), high-purine foods (particularly meat and sea food ), leguminous vegetables (like chickpea, peanuts, lentils) and fructose-sweetened drinks Medications, such as diuretics, renin-angiotensin system agents, beta-blockers , cyclosporin, tacrolimus, low-dose aspirin (≤325 mg/day) Clinical Presentation The most common initial presentation is a self-limiting acute attack. Typical episodes of acute gout are characterized by severe pain, erythema, warmth, and swelling of 1 or more joints, peaking within 24 hours and with spontaneous resolution within 7-14 days . The first metatarsophalangeal joint (big toe joint) is most commonly affected . O...

Introduction Tumour lysis syndrome is an oncologic emergency that is caused by the massive release of breakdown products from malignant cells ; results in hyperkalaemia, hyperuricemia, hyperphosphatemia and hypocalcaemia. Renal damage and arrhythymias can follow. NOTE: Tumor lysis syndrome can be either spontaneous or treatment related. Cairo and Bishop Classification Risk Factors The syndrome is more common With some haematological malignancies, e.g. acute leukaemias, non-Hodgkin lymphomas With tumours that have a high proliferative rate, large tumour burden or high sensitivity to the antineoplastic. With the first cycle of chemotherapy (usually occurs within 12-72 hours after administration, although in some cases, it may occur before chemotherapy). In patients with decreased urinary flow, pre-existing hyperuricemia, renal impairment, dehydration or acidic urine. Prevention Prevention is important. Aggressive hydration (sometimes with diuretics to maintain urine output) promotes ur...