Author Archives: Dr. Rupesh Gupta

What Are The Most Characteristic Side Effects Of Colchicine?

Colchicine is an alkaloid derived from a plant called Autumn crocus. This medicine is widely used for the management of pain and inflammation in gout. however, it has minimal effects on synthesis of uric acid and/or excretion of uric acid. Primarily, colchicine is an anti-inflammatory and reduces swelling in gout. How colchicine prevents release of chemotactic factors or inflammatory cytokines from neutrophils is not clear. However, this process prevents attraction of more neutrophils to affected areas.

It was very well absorbed by oral administration and normal dose is 0.6 mg in the form of tablet. colchicine concentrates in spleen, kidney, liver, gastrointestinal tract and leucocytes.

colchicine is contraindicated in pregnancy and its fatal dose is 10 MG to 20 MG.

It was metabolised in the liver and 70% excreted in faces. The remaining 15 to 30% is removed by urine. Besides being used in the treatment of inflammation in acute gout, it is also used as diagnostic aid in hyperuricaemia. Generally, the doctor will give colchicine in a patient with acute swelling of joints. If the results are seen within a few hours, and the swelling and pain subsides, then it is considered as gout, otherwise it might be diagnosed with fine needle aspiration are other methods such as blood and urine tests or x-rays.

This is how you should take colchicine in gout. When you have to first sign of attack, take first dose, then continue taking at intervals of two hours until the symptoms subside. If the symptoms don’t subside and you continue taking colchicine in excess, you might have diarrhoea. If you suffer from diarrhoea while on this medicine, you should stop taking it with immediate effect. In any case, you should not exceed 6 to 7mg in a day. The pain is generally relief in 48 hours. Sometimes you are advised by your practitioner to take colchicine in small doses during asymptomatic periods to prevent the gout flare.

You should be cautious in using colchicine if you have conditions associated with heart, kidney, gastrointestinal tract or have liver diseases like cirrhosis or hepatitis. Colchicine is considered a safe drug. However, side effects • do occur in many patients. 80% of the cases show mild side effects which are:-

  1. diarrhoea
  2. nausea
  3. cramping
  4. abdominal pain
  5. vomiting
  6. if patient has consumed larger doses that is more than 7mg, the following symptoms might happen:-
  7. Bloody diarrhoea
  8. shock
  9. burning sensation of throat
  10. alopecia
  11. decreased neutrophil count
  12. reduced urination
  13. blood in urine
  14. aplastic anaemia
  15. CNS depression
  16. myopathy.

If the patient has been taking colchicine for long time, research shows its association with colon cancer.

Where Can Uric Acid Crystals Form?

Uric acid crystals are formed in liver by purine metabolism. As Uric acid is not required by our body, it has to be eliminated. It is generally removed from our body via three routes. 70% of uric acid is excreted by the kidneys as urine. Approximately 30% of uric acid is removed through feces. 1 to 2% of uric acid is also removed through skin via perspiration.

Generally speaking, crystallisation occurs when either the surrounding temperature gets colder or concentration of solute, in this case  uric acid, increases above normal range. Body temperature of our core which includes thorax, abdomen and internal organs including the deep tissues of the body is within the range of 33°C to 37°C. At this temperature more uric acid crystals are dissolved in blood. So, internal organs have minimal effects of crystallisation unless the concentration of uric acid increases.

In extremities, however, especially in smaller joints like hands and feet, the situation is different. These parts of our body are exposed to external environment, mostly unprotected. There is the temperature of the blood flowing to those parts of the body drops and we see crystallisation of uric acid in these joints.

Additionally, the joints in these parts of the body namely hand and feet are small. So, even though little accumulation of uric acid crystals in these joints will start the injury process and thus your joints become inflamed and painful.

If your blood uric acid levels are markedly high however the set crystals can cause microscopic inflammation throughout the body. This happens more often and diligence.

, If you have been suffering from gout for more than a few years, you will be at risk of developing many other diseases like kidney stones, kidney failure, hepatitis, pancreatitis, diabetes and other inflammation of organs. Thus, you look acid crystals can form in any part of the body depending on body temperature and concentration of uric acid in the blood.

Are Gout And Fatty Liver Related?

Gout is a medical condition where due to some metabolic causes, an elevated serum uric acid level is observed. Uric acid is a metabolic product of purine and is produced mainly in liver and intestines. Once produced, uric acid has no use in the body and has to be eliminated via excretory system. If we eat a lot of animal proteins in our daily diet and drink less water or normal amounts of water, our body will be unable to excrete uric acid from body and thus accumulation will start happening.

There are two main ways, uric acid is excreted from our system. Feces or stool contributes up to 30% of the total amount of uric acid excretion. Major contributor (up to 70%) towards removal of this metabolic waste is kidney.Our body needs a lot of water (from 2.5 to 3 litres a day), so as to dissolve the uric acid and to make sure it does not get deposited in smaller joints or organs.

Animal proteins, soybean, beer and other foods which are high in purine, tend to increase the levels of uric acid in the body.Research says, if you have gout and do not drink beer, you might have the probability of developing non-alcoholic fatty liver disease. What if you drink beer? Even worse. The underlying process of fat deposition on liver is pronounced in cases having gout. If you are alcoholic, it might increase the chances of getting hepatitis by multiple folds.

But, why is it so? Uric acid forms crystals either at lower temperatures or higher concentrations. It’s just like any other crystal. Let’s say salt or sugar crystal. Take some salt, keep it on paper and rub it hardly on it. What happens? On a microscopic level or even on a macroscopic level, you can see scratches. Try doing it with sugar crystals to understand it better. This is what uric acid  does to your tissues in the body at higher concentrations. By causing injury at microscopic levels, it causes inflammation and when it starts in liver, liver starts depositing fat tissue around it, until 90% of liver gets inflamed. Once you reach at that stage, you get a cirrhotic liver disease which is non-reversible injury to liver.

The above process does not only happens in liver alone. It can happen in any other organ, including kidneys, pancreas, spleen, intestines, lungs, etc.

In conclusion, when you have gout or high levels of uric acid in blood you are at an increased risk of non-alcoholic fatty liver disease and other inflammatory conditions throughout the body, which takes time to show up.

Are Kidney Stones Dangerous?

Stone formation can occur anywhere in the body where there is little bit of space and the organ or tissue deals with a lot of fluid circulation and/or secretion. It is an indication of slowing down process which can result from either food, lifestyle or ageing process. Food and lifestyle are two main factors responsible for all diseases of mankind as we know it. We have other factors, which western medicine calls genetics, but generally speaking if you have control over your lifestyle, you can manage (to the very least) or heal most of the diseases.

Same is with kidney stones. Wherever there is a formation of a unwanted substance (why do I call that? Well, anything which is supposed to be excreted, but is somehow embedded in you, is of course an unwanted substance), that substance will cause damage.

If it is kidney stone, then it has an impact on kidney. It might also increase your blood pressure and might even cause cancer. Is it so? Well, yes. Certain type of kidney stones, especially oxalate stones and uric acid stones, if untreated, may cause cancer because these stones have sharp edges and are responsible for continuous irritation of kidneys.

So, yes kidney stones are dangerous. Kidney stones might in turn complicate into high blood pressure because of impaired kidney function and if that happens, it leads to a vicious cycle of events. Increase of blood pressure in turn increases the chances of kidney damage.

It is always better to be on preventive side rather than having a elvish lifestyle and crap food. We must workout everyday, even if it is just only 30 minutes. Additionally, we shall reduce the intake of animal proteins and reduce salt intake to prevent our kidneys.

What Color Is Uric Acid In Urine?

Urine itself can have a variety of colours, depending upon the amount of fluids you take in 24 hours time. For instance, mongering is the most concentrated because we normally do not drink fluids during night. Uric acid crystals are reddish orange in colour and provide similar colour to the urine.
normal transparent urine color
The image above shows the urine colour when you drink 2.5 to 3 L of water every day. Even becomes clear white in colour. You should drink 2.5 to 3 L of water a day in normal routine to maintain proper balance of electrolytes in the body. A simple rule of 200 ml water every hour for 15 hours of the will keep your body hydrated and clear of most of the toxins. The moment you start reducing consumption of fluids or increase exercise or work in hot sun (leading to dehydration or loss of water), the urine starts to concentrate, thus increasing the risk of stone formation in the kidneys. The following image shows the colour of urine when you drink too little of the fluids a day. The uric acid is concentrated in this type of urine and carries a risk of forming uric acid stones in renal system.

concentrated urine color

Remember, drinking less water is the single most important factor in formation of all type of stones in kidneys are your ureters. Even if your diet is high in calcium, oxalates or purines, if your water intake is optimum, this research shows that you will have reduced the risk of having kidney stones to more than 90%.

In conclusion, urine colour is determined by the hydration level of your body. If the colour of urine is colourless to straw colour, you have optimum fluid intake. Otherwise if your urine shows Amber to reddish orange colour, it means you have less water intake or you have been working in the hot sun, thus dehydrating your body.