Gout Gus — Gout: Uric Acid Crystals, the Angry Big Toe & Purine Teaching
He woke at 2 a.m. with a big toe so hot and swollen the bedsheet felt like a blade
Gus wakes at 2 a.m. with searing pain in his right great toe. It is red, hot and so tender he cannot bear the weight of the sheet.
Gus's uric acid builds up faster than his kidneys can clear it, and needle-shaped urate crystals settle into the coolest joint — classically the great toe. The joint becomes red, hot, exquisitely tender and swollen, often overnight. Attacks are triggered by alcohol (especially beer), purine-rich foods like organ meats, shellfish and red meat, dehydration and diuretics. Acute attacks are treated with anti-inflammatories or colchicine; allopurinol prevents future attacks but is never started during an acute flare and takes weeks to work.
Read Gout Gus's full story →The story arc
The setup
Gus enjoys beer, steak and shellfish, takes a thiazide diuretic for blood pressure, and drinks little water.
The turn
He wakes overnight with an intensely painful, red, hot, swollen right great toe that cannot tolerate touch.
The crisis
Gus tries to walk it off, keeps drinking beer, and by day three he has a fever and firm white nodules on his ear.
The save
The acute flare is treated with anti-inflammatory therapy, the joint is rested and elevated with a bed cradle, and allopurinol is started only after the attack settles.
NCLEX study section — Gout: Uric Acid Crystals, the Angry Big Toe & Purine Teaching
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Health Assessment
Take this chapter into practice questions on the same topic.