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CHEMISTRY LEGEND
June 2018
Hypouricemia
Hypouricemia is a level of uric acid in blood serum that is below normal. In humans, the normal range of this blood component has a lower threshold set variously in the range of 2 mg/dL to 4 mg/dL, while the upper threshold is 530 micromol/L (6 mg/dL) for women and 619 micromol/L (7 mg/dL) for men. Hypouricemia usually is benign and sometimes is a sign of a medical condition.
Causes
Hypouricemia is not a medical condition itself (i.e., it is benign), but it is a useful medical sign. Usually hypouricemia is due to drugs and toxic agents, sometimes it is due to diet or genetics, and rarely it is due to an underlying medical condition. When one of these causal medical conditions is present, hypouricemia is a common sign.
Medication
The majority of drugs that contribute to hypouricemia are uricosurics (drugs that increase the excretion of uric acid from the blood into the urine).Others include drugs that reduce the production of uric acid: xanthine oxidase inhibitors, urate oxidase (rasburicase), and sevelamer
Diet
Hypouricemia is common in vegetarians due to the low purine content of most vegetarian diets.] Vegetarian diet has been found to result in mean serum uric acid values as low as 239 µmol/L (2.7 mg/dL).While a vegetarian diet is typically seen as beneficial with respect to conditions such as gout, care should be taken to avoid associated health conditions
Genetics
Genetic mutations known to cause hypouricemia are of two kinds: mutations causing xanthine oxidase deficiency, which reduces the production of uric acid; and mutations causing abnormal kidney function that increases the excretion of uric acid. Collectively known as familial renal hypouricemia, these latter mutations are of two types, involving defects of presecretory and postsecretory reabsorption.
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A genetic mutation in Dalmatian dogs causes hypouricemia due to a kidney defect that interferes with reabsorption of uric acid. A similar mutation has been reported in a human brother and sister.
Diagnosis
Routine blood examination may suggest low serum (blood uric acid) level.
Blood examination to evaluate cause of pelvic or flank pain may indicate low serum uric acid level.
Normal range of blood uric acid is 2 mg/dl to 4 mg/dl.
Uric acid clearance test- Normal or reduced clearance is caused by abnormal xanthine oxidase.
Treatment
Asymptomatic Hypouricemia.
o No treatment.
o Observe any abnormal symptoms and frequent blood examination.
o Increased protein in diet.
Symptomatic Hypouricemia.
o Low blood uric acid may be caused by increased excretion of uric acid in urine known as “hyperuricosuria’.
o Higher uric acid in urine may result in uric acid stone, which may cause symptoms.
o Hyperuricosuria (higher excretion of uric acid) is treated by maintaining urine pH at 6 to 6.5 by drinking excessive water. Excess water is excreted in urine and maintains low ph. Low urine pH increases reabsorption of uric acid.
o Potassium citrate is prescribed to be taken every day or alternate day.
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References
1. https://en.wikipedia.org/wiki/Hypoxemia 2. https://www.epainassist.com/abdominal-pain/kidney/renal-hypouricemia
Questions
1. Define the term Hypouricemia. 2. Discuss the causes of Hypouricemia. 3. How can Hypouricemia be treated?
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