Total fasting, hyperuricaemia and gout.

The purpose of this communication is to draw attention to the apparently harmless hyperuricaemia which results from treating obese patients by total fasting. In such patients there is a progressive fall in the glomerular filtration rate during the fasting period resulting in the renal retention of urate (Murphy & Shipman, 1964). In addition there is competition between the ketone bodies and urate for the same, or a similar, renal transport mechanism (Cheifetz, 1965); this also results in the renal retention of urate. The resultant hyperuricaemia is on occasions gross, and has been associated with the acute joint disturbance typical of gout in a significant number of patients in the reported studies of Bloom (1959), Duncan, Frazer & Cristofori (1962) and Drenick et al. (1964). Consequently, a history of gout in an obese patient has been accepted as being a strong contraindication to treatment by total fasting. Gilliland (1968) commenced probenecid therapy before the starvation period in patients with gout. To date, we have studied forty-two obese patients treated by total fasting. The periods of observation ranged from a minimum of 3 weeks to 8 months, in the individual subject. Elevated levels of serum uric acid occurred in all, and in Table 1 the maximum serum uric acid levels are recorded. Despite this none