اوردر ها:

1️⃣ Admit to:
2️⃣ Impression: Acute gout attack
3️⃣ Condition:
4️⃣ Vital Signs: tid
5️⃣ Activity: Bed rest with bedside commode
6️⃣ Nursing: Keep foot elevated; support sheets over foot; stool sample for OB (occult blood).
7️⃣ Diet: Low purine diet.

8️⃣ داروها : Ibuprofen (Motrin) 800 mg, then 400-800 mg PO q4-6h OR
Diclofenac (Voltaren) 25-75 mg tid-qid with food OR
Indomethacin (Indocin) 25-50 mg PO q6h for 2d, then 50 mg tid for 2 days, then 25 mg PO tid OR
Ketorolac (Toradol) 30-60 mg IV/IM, then 15-30 mg IV/IM q6h or 10 mg PO tid-qid OR
Naproxen sodium (Anaprox, Anaprox-DS) 550 mg PO bid OR
Methylprednisolone (SoluMedrol) 125 mg IV x 1 dose
THEN
Prednisone 60 mg PO qd for 5 days, followed by tapering.
Colchicine 2 tablets (0.5 mg or 0.6 mg), followed by 1 tablet q1h until relief, max dose of 9.6 mg/24h. Maintenance colchicine: 0.5-0.6 mg PO qd-bid.

Hypouricemic Therapy:
Probenecid (Benemid), 250 mg bid. Increase the dosage to 500 mg bid after 1 week, then increase by 500-mg increments every 4 weeks until the uric acid level is below 6.5 mg/dL. Max dose 2 g/d. Contraindicated during acute attack.
Allopurinol (Zyloprim) 300 mg PO qd, may increase by 100-300 mg q2weeks. Usually initiated after the acute attack.

9️⃣ سایر داروها در صورت لزوم :Famotidine (Pepcid) 20 mg IV/PO q12h.
Meperidine (Demerol) 50-100 mg IM/IV q4-6h prn pain OR
Hydrocodone/acetaminophen (Vicodin), 1-2 tab q4-6h PO prn pain.
Docusate sodium (Colace) 100 mg PO qhs.
Acetaminophen (Tylenol) 325-650 mg PO q4-6h prn headache.
Zolpidem (Ambien) 5-10 mg qhs prn insomnia.

آزمایشات : CBC, SMA-7 (BUN/Cr, Electrolytes (Na, K, Cl, HCO3, ...), BS), uric acid. UA with micro. Synovial fluid for light and polarizing micrography for crystals; C&S, Gram stain, glucose, protein, cell count.