ABSTRACT
@#Mr Tan, 60, a smoker with diabetes mellitus (DM), hypertension and chronic kidney disease (CKD) Stage 3, and recurrent gout flares last five weeks of increasing intensity and duration. He assumes it is due to frequent travel and lack of exercise. He comes today for routine review of his chronic diseases. Current laboratory results are creatinine 106, eGFR 56, uric acid 490, HbA1c 7.3%, random hypocount 8.5 mmol/L. He is on glipizide 5mg bd, Metformin 250mg BD, Amlodipine 5mg OM. He complains of severe gout pain. He had always been reluctant to start definitive treatment which you had previously mentioned. What will you do next?
ABSTRACT
@#Mr Tan, 60, a smoker with diabetes mellitus (DM), hypertension and chronic kidney disease (CKD) Stage 3, and recurrent gout flares last five weeks of increasing intensity and duration. He assumes it is due to frequent travel and lack of exercise. He comes today for routine review of his chronic diseases. Current laboratory results are creatinine 106, eGFR 56, uric acid 490, HbA1c 7.3%, random hypocount 8.5 mmol/L. He is on glipizide 5mg bd, Metformin 250mg BD, Amlodipine 5mg OM. He complains of severe gout pain. He had always been reluctant to start definitive treatment which you had previously mentioned. What will you do next?
ABSTRACT
Oxidation of lactate at rest (RE, n=4), or after short strenuous exercise (EX, n=6) was investigated in rats. Food and water were given ad libitum before experiment. In EX, rats ran to exhaustion at the speed of 80-100 m·min<SUP>-1</SUP>. Immediately after exercise, 4 μCi of (U-<SUP>14</SUP>C) lactate was injected into aorta through an indwelling catheter. In RE, (U-<SUP>14</SUP>C) lactate was injected into the rats at rest. Expired gas was collected by a Brooks type bottomless chamber on treadmill belt for 120 min. In EX, exercise duration was 109±18 sec (mean±SE), and maximum blood lactate concentration after the exercise was 23.7±2.1 mM (mean±SE) . Cumulative percent recovery of <SUP>14</SUP>C as <SUP>14</SUP>CO<SUB>2</SUB> for 120 min was 48.5±2.8% for EX and 61.7±0.9% for RE (mean±SE) . Significant difference was found between these two rates (p<0.01) . After 50 min of recovery, mean volume of <SUP>14</SUP>CO<SUB>2</SUB> expired per min in RE was significantly greater than that in EX (p<0.01) . Mean volume of <SUP>14</SUP>CO<SUB>2</SUB> expired per min per VCO<SUB>2</SUB> in RE was always greater than that in EX, and significant difference was found at 7.5 min of recovery (p<0.01) . It is concluded that although the rate of recovery of <SUP>14</SUP>C as <SUP>14</SUP>CO<SUB>2 </SUB>after exercise is lower than that at rest, the major pathway of lactate metabolism after short strenuous exercise is oxidation.