A 47-year old man presents with severe pain in his right great toe. He is unable to bear weight on his right foot and there was no apparent trauma. He reports the pain started last night and continued to increase in severity. Based on his physical exam and laboratory findings he is diagnosed with gout. Gout can be caused by several different mechanisms and blood samples are drawn and urinalysis is performed. The results from this individual are listed below.Patient Plasma Urate(mg/100ml) Urinary Uric Acid(mg/24hr)Normal <7.0 413±78Patient 10.5 215 What is the best explanation for the presentation of gout in this individual and please explain why the other choices are not consistent with the data or what additional information you may need to decide the root cause?1. overproduction of purines2. decreased salvage of purines3. decreased urinary excretion of uric acidAfter further discussion with the patient, he tells you that he recently switched from diet soda to regular soda because he read that the ‘fake sugar’ diet soda was bad for him; he tells you he drinks between 4 and 5 L of soda a day. (NOTE: The primary sugar in most sodas is fructose or high fructose corn syrup.)What is the potential impact of this dietary modification on the presentation of gout?

Respuesta :

Answer:

the best explanation is 1. overproduction of purines

Explanation:

Purines are nitrogenous base that are broken down to uric acid which is excreted through the kidney as a constituent of urine. Different conditions that lead to an impaired removal of plasma uric acid cause gout. Soda drinks and many soft drinks contain low levels of purines and high level of fructose. Fructose is the only carbohydrate known to increase uric acid levels by increase the rate of  degradration and synthesis of purine