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Abstract: The patient presented with pain in the medial aspect of the first toe of the right foot 2 days ago without any obvious cause, and the symptoms gradually worsened, preventing him from walking normally. The patient had high uric acid for 2 years without treatment, and was hospitalized with a preliminary diagnosis of gout. After hospitalization, he was treated with anti-inflammatory and analgesic treatment, i.e. symptomatic supportive treatment, using the drugs ranitidine hydrochloride injection and naproxen sodium for injection. After 5 days of hospitalization, his condition improved, and he was discharged home to continue medication treatment with diclofenac sodium enteric slow-release capsules, nifedipine controlled-release tablets, benzbromarone tablets, and sodium bicarbonate tablets.
[Basic Information] Male, 51 years old
Disease Type】Gout
Hospital】The First Hospital of China Medical University
Date of consultation】January 2022
Treatment plan】Medication (ranitidine hydrochloride injection, naproxen sodium for injection, diclofenac sodium enteric slow-release capsule, nifedipine controlled-release tablet, benzbromarone tablet, sodium bicarbonate tablet)
Treatment period】5 days of hospitalization, 1 week of review, follow up on discomfort
Treatment effect】After 5 days of hospitalization, the pain of the first toe of the right foot was significantly reduced.
I. Initial consultation
The patient presented with pain in the medial aspect of the first toe of the right foot 2 days ago without any obvious cause, and did not undergo treatment. The patient’s right foot was examined and found to be locally red and swollen, without ulceration, with normal body temperature. The patient was able to eat well after the onset of the disease, but the quality of sleep was poor, and the urine and stool were normal. After the onset of pain in the medial aspect of the first toe of the right foot, the patient did not undergo any treatment and came to our hospital in order to alleviate the symptoms. The patient reported that he had a history of hypertension for 6 years and high uric acid for 2 years, but was not treated. After hospitalization, the patient was asked to complete ancillary tests such as blood sedimentation and uric acid, and the results were 43.0 μmol/L total bilirubin, 13.2 μmol/L direct bilirubin, 29.8 μmol/L indirect bilirubin, and 519.5 μmol/L uric acid.
II. Treatment history
I explained the condition of gout to the patient and his family and informed them of the possibility of drug treatment, to which they agreed, so the patient was given anti-inflammatory and pain relief and symptomatic support intravenous drip treatment after hospitalization, using the drugs ranitidine hydrochloride injection and naproxen sodium for injection. After 5 days of hospitalization, the patient improved and was discharged home to continue medication, including diclofenac sodium enteric slow-release capsule, nifedipine controlled-release tablets, benzbromarone tablets, and sodium bicarbonate tablets. 1 week of follow-up examination showed no discomfort, so the patient could continue to take medication as prescribed by the doctor and follow up the discomfort.
III. Treatment effect
One day after hospitalization, the pain of the first toe of the right foot was less than before, and there was no fever or other abnormalities. After 5 days of hospitalization, the pain of the first toe of the right foot was significantly reduced, the redness and swelling had also subsided, and the indicators such as uric acid had decreased. One week after discharge, the patient reported that the pain of the first toe of the right foot had disappeared and did not affect normal walking and other activities.
IV. Notes
I was very happy when the patient’s symptoms were relieved, and instructed the patient to take the medication strictly according to the doctor’s prescription after discharge, and avoid stopping or reducing the medication in the middle of the day to avoid the recurrence of gout. After going home, you should pay attention to a high purine diet, especially now that you are still at the end of gout attack, it is not recommended to eat a high purine diet, mainly including seafood, beer, drinks, white wine, animal liver, etc., and your diet should be light. In addition, you can exercise according to your own situation, the main exercise methods include brisk walking, jogging, swimming and so on. When there is discomfort, you should go to the hospital in time to avoid holding back and waiting for the pain to be unbearable, which can easily delay the condition.
V. Personal insight
Gout is a group of metabolic diseases caused by long-term disorders of purine metabolism and/or reduced uric acid excretion. When high uric acid is detected it must be treated promptly and standardized. In daily life, we also need to pay attention to foods high in purines to avoid causing discomfort and affecting our lives after an attack. This patient has been found to have high uric acid for 2 years and has a history of hypertension, which is also not actively treated and can have an impact on the condition of gout. The patient’s symptoms were relatively mild and he cooperated actively with the treatment, and his condition was relieved. If it is any more serious, it may also have an impact on joint deformity. Therefore, it is important to actively treat the condition when discomfort occurs.