Have you ever been confronted with an illness that made you want to run away and barf?
In first grade I was sitting by this kid who was eating a salami sandwich. He burped in my face and I barfed everywhere! I got to go home (WIN!).
Anyway, the answer is, yes I’ve wanted to, although I haven’t yet. Despite seeing childbirth, afterbirth, horrible bloody bone-sticking-out trauma, people dying in front of my eyes, extremities rotting off, nasty autopsies, stage 4 decubitis ulcers (google this one), smelled and seen all manner of substances which come out of ANY and EVERY hole in the body!
my brother is a medical mystery with abnormally high uric level acid, thoughts?
High uric acid in the blood, called hyperuricemia (hyper- for high, and -emia for blood), is bad because it can cause gout, uric acid kidney stones or indicate an underlying abnormal growth of cells. Hyperuricemia can be caused by four main pathways:
(1), eating foods that form uric acid upon digestion such as beer and red meats. These foods can actually precipitate gout attacks. The dietary metabolic precursors of uric acid are called purines which also serve as building blocks of DNA.
(2), increased cell degradation which produces uric acid due to cellular DNA breakdown. This situation is seen during chemotherapy (when a large population of cells are being killed) and is bypassed by giving prophylactic medicine. This situation is also seen in malignancies with high cell turnover such as leukemias.
(3), genetic predisposition for overproduction of uric acid. This is due to variation of the speed at which enzymes produce uric acid.
(4), decreased urinary excretion of uric acid. This can be caused by certain blood pressure and diabetes medicines or may be genetic.
So, for any patient with hyperuricemia who is otherwise asymptomatic, I would order a slate of tests: complete blood count with differential, peripheral blood smear, complete metabolic panel, liver function tests, blood sugar, thyroid stimulating hormone then start them on a low purine diet. Once on the diet for a week or two, I would get post-diet blood uric acid levels and a 24 hour urine collection with uric acid determination. Using the pre-diet and post-diet uric acid levels and uric acid excretion value, one can determine the patient’s cause of hyperuricemia. It is one of the categories from above: (1) high purine intake, (2)-(3) overproduction or (4) underexcretion. From there we can determine how to treat the problem. The treatment may be to simply continue the low purine diet or may include medicine which inhibits the formation of uric acid (allopurinol) or medicine which increases the urinary excretion of uric acid (probenicid). Also, for anyone at risk of kidney stones such as patients with hyperuricemia it’s advisable to stay very well hydrated as this will help prevent the precipitation of a stone.