Gout and DCS?

[T. Bix]

It is my understanding that gout is caused by a build up of uric acid and the inability of the body to adequately deal with this nitrogenous waste. My question is: Is there an additional risk of DSC during a gout flare up? Or even in general since uric acid is after all nitrogenous and therefore already present flare up or not. And will Nitrogen tend to build up in joints prone to gout attacks and thus be most likely where DCS symptoms will first occur?

 

[Thalassamania]

Read Doc Vikingo's Scuba Clinic on the subject.

 

[bvanant]

I am not sure why you think N2 gas will dissolve more readily in uric acid than in the rest of the blood. In normal (non-gout) folks, uric acid concentrations are typically 4 to 8 mg/dl which are very low by say protein or glucose levels. Precipitation of uric acid crystals is typical of gout, but often gout is seen in folks with "normal" levels of urate in the blood. There is no chemical reason that N2 should dissolve more readily into blood or tissue that has slightly higher or lower urate levels or even into uric acid crystals, but it may be true that gout can mimic DCS.
Bill

 

[T. Bix]

I'm not sure how you can determine what I think but I did ask some questions because I don't know and am concerned about anything to do with nitrogen build up. I can fix your car, boat, airplane, or big rig but not your body or mine that is why I asked questions of this nature. I am a mechanic not a doctor and as such thought there may be someone able to shed some light on the body's ability to deal with nitrogen. But what I do take away from your post is that I need a blood test to determine what my uric acid level is and a potential plan to control it. However my concern is more along the line of uric acid releasing disolved nitrogen thereby reducing my body's tolerance to absorb and disapate disolved nitrogen. I just don't know if I should be concerned or not....... Thank You for your input.


Thalassmania, Thanx the post almost touches on my concerns, I appreciate any info that can help.

 

[TSandM]

If I am reading you correctly, you are concerned because uric acid is a nitrogenous waste, that its dynamics are somehow related to inhaled and dissolved nitrogen. This is not the case. "Nitrogenous waste" refers to the breakdown products from protein metabolism. The nitrogen in this case is chemically bound to other atoms, and is not gaseous N2. Urates won't contribute to your nitrogen loading or change the amount of dissolved nitrogen your blood can hold.

There is possibly a theoretical concern about DCS risk in areas of intense inflammation, but I'd be a lot more worried about your functional status (ability to kick, climb boat ladders, etc.) with an active gout flare than I would be about the inflamed joint serving as a DCS nidus.

 

[Dr Deco]

Hello T. Bix:

DCS

As best as anyone can tell, the pain of DCS is related to gas bubbles in the connective tissue associated with movable joints, e.g., knee, shoulder, elbow, etc. as the bubbles grow, they exert pressure on nerve endings and pain results. [That is the hypothesis, anyway.] The mechanism for bubble formation from dissolved nitrogen in the breathing gas is quite different from crystal formation leading to gout.

Gout

Gout, on the other hand, is associated with sodium urate or uric acid crystals forming in the synovial fluid or tissues surrounding joints[e, the big toe]. The two conditions are separate – except for the pain part! The primary concern would be to mistake true DCS for an attack of gout and miss securing a hyperbaric treatment. [ I have had gout myself and could definitely tell gout from DCS pain.]

Gout does not predispose a diver to DCS. I have not heard of any statistical association of DCS risk and the condition of gout. The other earlier SCUBA BOARD responders have indicated the same information.

Dr Deco :doctor:

 

[bvanant]

Sorry if I offended you, I guess I misinterpreted what you meant.
My understanding is that uric acid comes from purine metabolism and purines are components of DNA and RNA (but not proteins if I remember my first year biochem) and are found in high concentrations in foods like meats and seafood. As Dr. Lynne points out there is no way that the nitrogen from the uric acid can come out into the blood.

Bill

 

[Charlie99]

Just one anecdotal observation .... I have mild gout in one big toe and take allopurinol to keep down blood uric acid levels.

If anything, frequent prolonged diving reduces any little twinges I'm feeling in the big toe. My finning style puts little or no stress on my big toe, so diving doesn't aggravate it.

Perhaps the slightly elevated ppO2 from diving is a mild form of hyperbaric oxygen treatment?

Then again, it might just be that I feel really good when diving, and it's all psychosomatic.

 

[FritzCat66]

Another gout sufferer and diver here. Anecdotally, before I got on Allopurinol, I actually noticed a decrease in frequency and intensity of the gout on weekends when I dove. However, I think that was a side-effect of consciously remaining extremely well hydrated; something I take very seriously about diving - in other words, it wasn't the diving itself per se that was affecting the gout one way or another.

I've been on Allopurinol for 18 months or so now; the acid levels are staying below 7 mg/dL and I really no longer worry about it or feel any effects anymore (no side effects either - qualifying Allopurinol as a "miracle drug" in my book!). Still staying hydrated for the dives, tho...

 

[T. Bix]

If I am reading you correctly, you are concerned because uric acid is a nitrogenous waste, that its dynamics are somehow related to inhaled and dissolved nitrogen. This is not the case. "Nitrogenous waste" refers to the breakdown products from protein metabolism. The nitrogen in this case is chemically bound to other atoms, and is not gaseous N2. Urates won't contribute to your nitrogen loading or change the amount of dissolved nitrogen your blood can hold.

There is possibly a theoretical concern about DCS risk in areas of intense inflammation, but I'd be a lot more worried about your functional status (ability to kick, climb boat ladders, etc.) with an active gout flare than I would be about the inflamed joint serving as a DCS nidus.

This is exactly the information that I was looking for! Just one thing I wasn't concerned that the two "are somehow related" I was concerned that they "may be somehow related"
Thanks to everybody for your input even Bill!

Btw Bill: not offended just wanted it to be understood precisely what information I was seeking.
Thanx again