A Case of new onset hyperuricemia in a home health care patient with multiple chronic diseases
Introduction: Continuity of care in primary care is important both for the management of diseases and also recognizing new situations. In this case report, approach to a home health care patient with new onset hyperuricemia has been discussed.
Case: A 75 year old woman with congestive heart failure, hypertension, type 2 diabetes, atrial fibrillation, chronic kidney disease and stroke history is being monitored by Marmara University Home Health Care Services. In a routine blood test due to her kidney disease, the serum uric acid was found to be 14 mg/dl. When consulted with nephrology, this rise was not attributed to the kidney, citing a creatinine drop from 2.85 md/dl to 1.89 mg/dl and all other electrolyte levels being in the normal limits, and only daily allopurinol 150mg was recommended. Because of the uric acid level rise from 8-9 mg/dl to 14 mg/dl in a relatively short time, a visit was planned to rule out possible etiologies. During the visit, the patient did not have any complaints. We learned that her diet was not rich in meats, but she had a weight loss of 20 kg in 8 months. Also, we found out that the patient had breast cancer in 2001. Because it had been 15 years since the last treatment, the caregivers had not thought of it during prior history takings. There were no pathological findings in her physical examination. After ruling out other causes of hyperuricemia, the patient was consulted to geriatrics due to her cancer history, weight loss, and uric acid rise. They recommended ordering a PET scan to screen for cancer.
Discussion: In this case, the reasons that elevate serum uric acid levels are examined and the importance of continuity of care in primary care is emphasized.
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