This paper is only available as a PDF. To read, Please Download here.
Abstract
Serum and urine uric acid were evaluated during prolonged therapeutic fasting in 15
obese patients. With increasing ketonemia the serum uric acid rose from a control
value of ![Math Eq]()
at 7 days and then decreased progressively to ![Math Eq]()
by 28 days despite sustained ketonemia. The uric acid clearances were 5.5 ± 0.9,
1.8 ± 0.2, and 4.4 ± 1.5 ml/min at days 0, 7, and 28 of fasting. At the same times
the creatinine clearances were 114 ± 11, 80 ± 6, and 64 ± 6.3 ml/min. There was no
evidence of a renal tubular abnormality as assessed by glycosuria, bicarbonaturia,
or increased phosphaturia. Urate binding to plasma proteins remained unchanged. Acute
studies of the renal handling of uric acid revealed a uricosuric response to the administration
of sodium lactate or sodium bicarbonate by intravenous infusion and low-dose acetylsalicylic
acid orally. This renal tubular response departs significantly from that observed
during the overnight fasted state and could not be accounted for by extracellular
fluid volume expansion or the induced acid-base changes.
at 7 days and then decreased progressively to 
by 28 days despite sustained ketonemia. The uric acid clearances were 5.5 ± 0.9,
1.8 ± 0.2, and 4.4 ± 1.5 ml/min at days 0, 7, and 28 of fasting. At the same times
the creatinine clearances were 114 ± 11, 80 ± 6, and 64 ± 6.3 ml/min. There was no
evidence of a renal tubular abnormality as assessed by glycosuria, bicarbonaturia,
or increased phosphaturia. Urate binding to plasma proteins remained unchanged. Acute
studies of the renal handling of uric acid revealed a uricosuric response to the administration
of sodium lactate or sodium bicarbonate by intravenous infusion and low-dose acetylsalicylic
acid orally. This renal tubular response departs significantly from that observed
during the overnight fasted state and could not be accounted for by extracellular
fluid volume expansion or the induced acid-base changes.To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Metabolism - Clinical and ExperimentalAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Starvation in man.N Engl J Med. 1970; 282: 668-675
- Obesity: A serious symptom.Ann Intern Med. 1972; 77: 797-805
- Renal retention of uric acid induced by infusion of beta-hydroxybutyrate and acetoacetate.N Engl J Med. 1955; 272: 351-355
- Effects of food, fast and alcohol on serum uric acid and acute attacks of gout.Am J Med. 1967; 42: 38-57
- Hyperuricemia induced by high fat diets and starvation.Arthritis Rheum. 1965; 8: 799-822
- The effect of starvation, high fat diets, ketone infusions on uric acid balance.Metabolism. 1965; 14: 186-197
- Renal urate excretion in normal man.Nephron. 1975; 14: 21-32
- The kidney and uric acid excretion in man.Kidney Int. 1972; 2: 115-118
- Influence of the kidney upon urate homeostatis in health and disease.Am J Med. 1974; 56: 665-675
- Liver and kidney metabolism during prolonged starvation.J Clin Invest. 1969; 48: 574-583
- Quantitative analysis of uric acid on blood and urine methods and interpretation.Bull Rheum Dis. 1957; : 17-19
- An enzymatic spectrophotometric method for the determination of xanthine and hypoxanthine.Clin Chem. 1967; 13: 834-846
- The renal clearance of endogenous “creatinine” in man.J Clin Invest. 1948; 27: 645-654
- Fuels, hormones and liver metabolism at term and during the early postnatal period in the rat.J Clin Invest. 1973; 52: 3190-3200
- The binding of urate to plasma proteins determined by means of equilibrium dialysis.J Lab Clin Med. 1970; 75: 503-510
- Effect of sodium lactate infusion on urate clearance in man.in: 2nd ed. Proc Soc Exp Biol Med. 96. 1957: 809-813
- Impairment of glomerular filtration in fasting for obesity.Acta Med Scand. 1971; 190: 389-393
- Study of the paradoxical effects of salicylate in low intermediate and high dosage on the renal mechanisms for excretion of urate in man.J Clin Invest. 1959; 38: 1298-1315
- Mechanism for the paradoxical aciduria following alkali administration to prolonged fasted patients.Metabolism. 1975; 24: 915-922
- Paradoxical retention of uric acid by uricosuric drugs in low dosage.in: 2nd ed. Proc Soc Exp Biol Med. 96. 1955: 542-547
- Pyrazinoate excretion in the chimpanzee. Relation to urate disposition and the actions of uricosuric drugs.J Clin Invest. 1973; 52: 1946-1957
- Paradoxical uricosuric effect of lactate during prolonged fasting in man.Clin Res. 1973; 21: 1078
- The effect of fasting and food on the rate of purine biosynthesis de novo in the rat spleen.Clin Sci Mol Med. 1974; 46: 37-47
- The distribution of serum uric acid values in a population unselected as to gout or hyperuricemia. Tecumseh, Mich. 1959–1960.Am J Med. 1965; 39: 242-251
- Uric acid clearance in patients with gout and normal subjects.Ann Rheum Dis. 1971; 30: 285-289
- Uric acid production in gout.J Clin Invest. 1961; 40: 1304-1314
Article info
Publication history
Received:
August 11,
1975
Footnotes
☆Supported by grants from the Canadian Arthritis and Rheumatism Society, the Medical Research Council of Canada (MA5623, MA4782), the Banting Research Foundation, the Toronto General Hospital Foundation, and the Herbert W. Follows Memorial Fund of the St. Michael's Hospital Research Society.
Identification
Copyright
© 1976 Published by Elsevier Inc.
