Blood partial acid

Introduction Blood acidity is also high in blood acid, because blood acid is blood uric acid, so it can also be expressed as high blood uric acid.

Cause

Causes of blood acidity: Hyperuricemia and gout can be caused.

an examination

Related inspection

Blood pH (pH)

Blood acidity check

[clinical manifestations]

I. Primary gout: In the past, it was considered rare in China, but in recent years, more factors have been discovered due to improved nutritional conditions, prolonged life expectancy, and attention to the disease. The prevalence increases with age and is more common in men. The ratio of male to female is about 20:1. Women rarely develop symptoms, and most of them occur after menopause. Many cases reported abroad have a positive family history, mostly autosomal inheritance, and a few are sexual inheritance. There are more cases of mental workers and economically well-nourished people. The course of gout is quite long. Those who have not been affected by the kidney have a good prognosis. They generally do not affect their longevity and can work and live like normal people. However, if the prevention is improper, not only the acute attack is very painful, but also easily lead to joint deformity and kidney stones. Serious consequences such as kidney damage, renal dysfunction, poor prognosis.

The natural course and clinical manifestations of gout patients can be roughly divided into the following four phases: 1 asymptomatic hyperuricemia, 2 acute gouty arthritis, 3 gout interval (inter-critical gout), 4 chronic tophi. Chronic tophaceous.

(1) Asymptomatic hyperuricemia: Serum urate concentration increases with age, and there are gender differences. There is no difference between men and women in childhood, with an average of 3.6 mg%. After sexual maturity, males are higher than females by about 1 mg%. After the menopause, the two tend to be close, so men can develop hyperuricemia after the developmental age, and women often occur after menopause. Many people with hyperuricemia can continue to have symptoms for a lifetime, called asymptomatic hyperuricemia, which is called gout only when arthritis occurs. The higher the serum urate concentration, the longer the time, the more chances of gout and urinary calculi. The age of onset of gout reaches its peak at around 40 years of age.

(B) acute gouty arthritis: is the most common first symptom of primary gout, occurs in the lower extremity joints, the typical onset of acute onset, patients can be very healthy when going to bed, but in the middle of the night awakened by foot pain Within a few hours, the symptoms developed to a peak, and the joints and surrounding soft tissues showed obvious redness, heat and pain, and the pain was so severe that they could not endure the cover of the bedding. Joint exudation may occur when the large joint is involved. It can be accompanied by systemic symptoms such as headache, fever, and increased white blood cells. Most patients have no prodromal symptoms before onset, but some patients have signs of fatigue, general discomfort, and local tingling before the onset. More than half of the patients were born on the toes of the feet, and about 90% of the patients were involved in the big toe throughout the course of the disease. The toe, ankle, knee, finger, wrist, and elbow joints are also good sites, while the shoulders, hips, and spine joints are less common. The initial onset often affects only a single joint, and repeated attacks increase the number of joints involved. It can occur in all seasons, but it is more common in spring and autumn. Most of the patients in the middle of the night. Local joint injuries such as sprained feet, walking with tight shoes and surgery, full catering, excessive fatigue, cold and humidity, and infection may all be predisposing factors.

Gout attacks last for several days to several weeks can be naturally relieved, joint activity can be completely restored, leaving only traces of skin color changes in the inflammatory area, and then there is an asymptomatic stage, the so-called gap period, which lasts for a natural month, several years or even more than ten years. Most patients relapse within a year. After that, they will be sent several times a year or several times. Occasionally, only one episode will occur once in a lifetime. A considerable number of patients have a tendency to become more and more frequent, and more and more joints are involved, causing chronic arthritis. Joint deformity, only a very small number of patients have no interstitial period since the initial attack, and directly continue to develop into chronic arthritis.

(3) tophi and chronic arthritis: In untreated patients, urate deposition in the joints increases, the recurrent inflammation recurs into the chronic phase and cannot completely disappear, causing joint bone erosion defects and surrounding tissue fibrosis, making the joints Stiff deformity and limited activity occur. On the basis of chronic lesions, there may still be repeated episodes of acute inflammation, which makes the lesions more and more serious, and the deformity becomes more and more significant, which seriously affects joint function. Individual patients have mild atypical symptoms in the acute phase and are found after the occurrence of joint deformity. A small number of chronic arthritis can affect the large joints and spine of the whole body joints including the shoulder and hip. In addition, urate crystals can be deposited in the tendons, tendon sheaths, and connective tissues of the skin near the joints, forming yellow-white, ridged creatures of different sizes, so-called gout nodules (or tophi), which can be as small as sesame seeds. Eggs or larger, often occur in the ear wheel, forearm extension, metatarsal toe, fingers, elbows, etc., but do not involve the liver, spleen, lungs and central nervous system. At the beginning of the nodule, the texture is soft, and as the fibrous tissue proliferates, the texture becomes harder and harder. The nodules in the vicinity of the joints are easy to wear, and the outer epidermis is thin and easy to break into a fistula. It can be discharged with white powdered urate crystals. However, secondary infection is rare because of bacteriocin. The tissue surrounding the fistula is chronic inflammatory granuloma and is not easy to heal. The occurrence of gout nodules is related to the stage of disease and the increase of blood urate. The general literature reports that blood urate is below 8mg/dl, 90% of patients have no gout nodules, and those with blood urate concentration over 9mg/dl, 50% have gout nodules, the longer the course of the disease, the more chances of gout nodules. The soft nodules with shorter time occur in the diet, and can be gradually reduced or even disappeared after the application of uric acid-lowering drugs, but the long-lived, hard-nodular nodules are not easy to disappear due to fiber proliferation.

(4) Renal lesions: About one-third of gout patients who have been seen in clinical practice for a long time have kidney damage, which is manifested in three forms:

1. Gouty nephropathy: urate crystal deposition in renal tissue causes interstitial nephritis. In the early stage, only proteinuria and microscopic hematuria may occur, and there is a gap, so it is easy to be missed. As the disease progresses, proteinuria becomes continuous. Sexuality, renal function, especially concentrated function is impaired, there is an increase in nocturia, the urine specific gravity is low, etc., the disease progresses further, and finally develops from chronic azotemia to uremic syndrome. In the past, about 17% to 25% of gout patients died of renal failure. Because gout patients are often accompanied by high blood pressure, arteriosclerosis, kidney stones, urinary tract infections and other diseases, the so-called gouty nephropathy may be the result of a combination of factors.

2. Acute renal failure: As a result of a large number of uric acid crystals that block the renal tubular lumen, leading to obstruction of urine flow and acute renal failure symptoms, such as giving active treatment such as drinking more water, alkaline drugs, lowering blood uric acid, etc. Often recoverable.

3. Urinary tract stones: About 20% to 25% of patients with primary gout complicated with urinary acid urinary tract stones. Some patients have symptoms of kidney stones earlier than arthritis. The incidence of urinary calculi is higher in patients with secondary hyperuricemia. Small sediment-like stones can be asymptomatic with the discharge of urine, and the larger ones often cause symptoms of renal colic, hematuria and urinary tract infections. Pure uric acid stones can be transmitted through X-rays without development, but those with more mixed calcium salts can be found on the urinary tract film.

Patients with gout are often associated with hypertension, hyperlipidemia, arteriosclerosis, coronary heart disease, and diabetes (type II). Among the causes of death in elderly patients, cardiovascular factors far exceed the factors of renal insufficiency. Regarding the relationship between gout and the above diseases, it is generally considered that there is no direct causal relationship, and may be related to obesity, diet, drinking, etc. Related factors. Limiting diet and reducing body weight often control hyperuricemia, diabetes, high blood pressure and hyperlipidemia.

Second, secondary gout: most occur in myeloproliferative diseases such as acute and chronic leukemia, polycythemia, multiple myeloma, hemolytic anemia, lymphoma and various cancer chemotherapy, the nucleic acid in the cell is decomposed and causes uric acid production. Too much; or in the kidney disease, high blood pressure, advanced arteriosclerosis, blood uric acid increased due to difficulty in uric acid excretion due to renal failure. The serum uric acid concentration in patients with secondary gout is often higher than that of the primary one, and the incidence of urinary calculi is also high, but because the course of the disease is not very long, the joint symptoms are not typical of the primary, and often the primary disease Covered, not easy to find. Because most of the patients are dying and their lifespan is not long, the performance in various chronic phases is relatively rare. In addition, drug-induced hyperuricemia often occurs when thiazide diuretics and diuretic acid, furosemide, and acetazolamide are used. Sodium salicylate has a beneficial effect on uric acid at high doses, and inhibits renal tubular excretion of uric acid at low doses to increase blood uric acid. Hyperuricemia and gout can occur due to kidney damage during chronic lead poisoning.

Adolescent and childhood gout is a rare disease, occasionally seen in hepatic glycogenosis type I, due to the lack of glucose-6 phosphatase, causing blood sugar lowering, causing increased glycogenolysis, excessive production of lactic acid, inhibition of renal tubular excretion of uric acid, and nuclear Glycoside consumption, increased sputum synthesis, results in hyperuricemia. Patients with paroxysmal hypoglycemia as the main performance. Followed by Lesch-Nyhan syndrome, due to the lack of hypoxanthine-guanine phosphoribosyltransferase (HGPRT), resulting in increased uric acid synthesis, showing hyperuricemia, the disease is seen in male children within one year of onset, often with cerebral palsy , mental decline, chorea-like hyperactivity and primary gout performance, light type often to the onset of adolescence, no disability signs, when the symptoms of gout appear to be noticed, the patient has a large amount of uric acid in the urine, uric acid stones often For the first symptom, the nervous system manifests only in 20% of patients, but only mild spinal-cylbellar motor disorders.

Differential diagnosis

diagnosis

Middle-aged men and above, sudden onset of the big toe, ankle, knee and other single joint swelling and pain, accompanied by increased blood urate, that is, gout may be considered, the sac fluid examination to find urate crystal can establish a diagnosis. General diagnosis is not difficult.

Blood acid confusing symptoms

Due to the diversity of the disease, sometimes the symptoms are not typical, the following differential diagnosis must be considered:

(1) Rheumatoid arthritis: More common in young and middle-aged women, it occurs in the joints of the fingers and the joints of the wrist, knee, ankle, ankle and spine. It is characterized by migratory symmetry and polyarthritis, which can cause Joint stiffness and deformity, repeated acute exacerbations on the basis of chronic lesions, easy to be confused with gout, but blood uric acid is not high, most rheumatoid factors are positive, X-ray shows joint surface roughness, joint space stenosis, even articular surface fusion, and gout bone The quality defect is significantly different.

(B) septic arthritis and traumatic arthritis: gout is often confused with septic arthritis or traumatic arthritis, but the latter two blood urate is not high, the sac fluid test without urate crystals, Traumatic arthritis often has a history of heavier injuries. The septic arthritis bursal fluid contains a large number of white blood cells, which can be used to identify pathogenic bacteria.

(3) Cellulitis: When the gout is acute, the soft tissue around the joint is often red and swollen. If the symptoms of the joint itself are neglected, it is easily misdiagnosed as cellulitis, the latter is not high in blood urate, chills and fever, and increased white blood cells. Systemic symptoms are more prominent, and joint pain is often less obvious. It is not difficult to diagnose.

(4) pseudo-gout: caused by calcification of articular cartilage, mostly seen in the elderly, the knee joint is most often involved, the symptoms are like gout in acute attacks, but the blood urate is not high, the joint synovial fluid is checked for calcium pyrophosphate crystals. Or phosphorus gray, X-ray film shows cartilage calcium.

(5) Psoriasis (psoriasis) arthritis: often asymmetry involving the distal intercondylar joint, with joint damage and disability, joint space widening, toe (finger) end bone absorption, ankle joints are often involved, clinical The performance is similar to rheumatoid arthritis, accompanied by 20% of patients with elevated blood uric acid, which is not easy to distinguish from gout.

(6) Other arthritis: The acute phase must be differentiated from lupus erythematosus, recurrent arthritis and Reiter syndrome, and the chronic phase must be differentiated from the sequelae of hypertrophic joint disease, traumatic and septic arthritis. diagnosis.

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