Yesterday, I went back to the Mineral Metabolism department at the school here. The initial reason I was evaluated there was for Osteoporosis or bone loss, probably exacerbated by a long intake of steroids... "Probably?"

Something odd showed up in the testing. Uric Acid was elevated to almost twice the normal range... He started me on Allopurinol...This, in itself is a concern, because I have a fatty liver and it can be toxic to the liver... Great, who is supposed to follow my liver and how? Liver enzymes? Internist? Rheumy? Whoever? This doc is a diagnostician, not one of my "many" regulars... Enzymes have been elevated in the past, esp w/NSAID's...

I know this is elevated in Gout, but I have never been told I had Gout, or even tested for it, as far as I can remember... Hyperuricemia is a term that keeps coming up in Google. Any idea why I would have this elevation? I do take a lot of AlkaSeltzer, and note a connection to aspirin...

Great, now I cannot feel a little safer taking something with aspirin to help avoid a heart attack or stroke...

In Gout symptoms, burning is mentioned, although I think it is supposed to be in the joints. My joints do burn (a lot, while I am trying to cut steroid dose), but I have burning in other areas too. Can Uric Acid burn in other areas?

Anyone have a clue here???

Cathie

As you know I am clueless so people correct me anyone. I had a very high liver for many years and went for many tests like ct scan. Anyhow now they are normal but a few things I would look at and are they sending you for ct scans so on?I know when in pain meds are needed but they do elevate the liver as you know. I don't know about asprin but yeas back I was not even aloud to take tylenol unless I had a fever over a certain amount and a very small amount. Also I had to go on a special diet because fats and carbs can add stress to your liver and digestion. This was key and each meal was in a certain ratio. Random I know you are trying to lower prednisone but does that cause liver issues?Back when my internist followed it but I also may be wrong a gi doc does too. Ok please correct me if this is mis info. Just sending thoughts alwasy to you and trying to offer 1% of what you help me with.

1) use of diuretics

2) low fluid intake

3) rapid die off of white cells. Often after an infection, there can be a temp
elevation of uric acid because purines in the die off of the white cells may overload the clean up.

4) genetic inability in handling purines

5) high fructose intake

drugs:
Drugs that can increase uric acid measurements include alcohol, ascorbic acid, aspirin, caffeine, cisplatin, diazoxide, diuretics, epinephrine, ethambutol, levodopa, methyldopa, nicotinic acid, phenothiazines, and theophylline.

Drugs that can decrease uric acid measurements include allopurinol, high-dose aspirin, azathioprine, clofibrate, corticosteroids, estrogens, glucose infusion, guaifenesin, mannitol, probenecid, and warfarin.

Alka Seltzer is sodium bicarbonate.

It will alter pH.

'Excessive use of sodium bicarbonate can result in increase acid secretion or systemic alkalosis.'

We can at times get into a bit of a 'pickle' by having more than one doc prescribing, and/or in addition taking over the counter substances.

If you are having gastric distress, there are other options. If you are not seeing a GI, and have gastric issues, perhaps you need to see one....ALSO touch base with your primary. Primary docs, who care for patients that see a lot of different specialists, can not possibly keep track of all the different drugs, tests etc, that the specialists oversee.

We have to keep the primary in the loop.

While it is good to be drinking the fluids with the Alka Seltzer, I am concerned that the sodium bicarb. is doing a dance on your system.

Let the doc know how much of the 'bubbly' you have been taking. You may want to call the doc and speak with his nurse regarding the Alka Seltzer issue....don't expect her to know off hand that it causes this..tell her you have just become aware of this, and wonder if it is necessary to take the allopurinol or if you can come in a few days from now....after stopping the Alka Seltzer.

uric acid is not used by the body to buffer the blood.

In fact when excess uric acid is present bicarb is often given to prevent stones:
http://www.springerlink.com/content/y07563vg47418p13/

While this is complex, it is still interesting:
http://www.medscape.com/viewarticle/407789_5

I would like to know how many times a day, Cathie, you are taking AlkaSeltzer.
Once a day should be enough for pain relief., for the burining I suggest it for.
I only use it at night and then only when burning is awful.

But bicarb is not causing your elevated uric acid..in fact it is used to treat people to prevent uric acid from crystalizing in the kidney:
http://www.peacehealth.org/kbase/top...614/detail.htm

Excess aspirin, however is an issue. But I think when aspirin is listed it has to be in "arthritic" amounts...that is used to treat RA = very high doses. Very high aspirin creates an acidic load in the blood. Raise acid= acid issues. Uric acid is acidic, obviously.

Aspirin (ASA) is associated with hyperuricemia.

I assume ASA is in Alka Seltzer....they don't tell people that in the commercials tho.....you think it is just plop plop fizz fizz.

I know it is basic, not acidic....aware of that, just concerned about how much bicarb she is ingesting on a daily basis.

I can't say how sodium bicarb ingested orally affects uremic acid if at all.

I did not find how much ASA is in the stuff. I imagine medscape drug reference has it.

I have no idea what Cathie's drug profile is, other than she is taking Alka Seltzer....that is pertinent.