Uric Acid, Blood and Urine

General

Synonym/Acronym:
Urate.

Rationale
To monitor uric acid levels during treatment with cytotoxic drugs for gout, leukemia, liver damage, psoriasis, renal function, and other conditions; to monitor patients being evaluated for starvation and other wasting conditions; to evaluate for kidney stones, particularly uric acid stones; and to assess the effectiveness of therapeutic interventions.

Patient Preparation
There are no food, fluid, activity, or medication restrictions unless by medical direction. For urine studies, usually a 24-hr urine collection is ordered. As appropriate, provide the required urine collection container and specimen collection instructions.

Normal Findings
Method: Spectrophotometry.

Blood
AgeConventional UnitsSI Units (Conventional Units × 0.059)
1–30 days
  Male and female2–6.2 mg/dL0.11–0.37 mmol/L
Child
  Male and female2.5–5.5 mg/dL0.15–0.32 mmol/L
Adult
  Male4–8 mg/dL0.24—0.47 mmol/L
  Female2.5–7 mg/dL0.15–0.41 mmol/L
Adult older than 60 yr
  Male4.2–8.2 mg/dL0.25–0.48 mmol/L
  Female3.5–7.3 mg/dL0.21–0.43 mmol/L
Therapeutic target for patients with gout: Less than 6 mg/dL (SI: Less than 0.4 mmol/L).
Urine
GenderConventional UnitsSI Units (Conventional Units × 0.0059)
Male200–1000 mg/24 hr1.48–4.72 mmol/24 hr
Female250–750 mg/24 hr1.48–4.43 mmol/24 hr
Values reflect average purine diet.

Critical Findings and Potential Interventions

Blood: Adults

  • Greater than 13 mg/dL (SI: Greater than 0.8 mmol/L)

Blood: Children

  • Greater than 12 mg/dL (SI: Greater than 0.7 mmol/L)

Timely notification to the requesting health-care provider (HCP) of any critical findings and related symptoms is a role expectation of the professional nurse. A listing of these findings varies among facilities.

Symptoms of acute renal dysfunction and/or chronic kidney disease associated with hyperuricemia include altered mental status, nausea and vomiting, fluid overload, pericarditis, and seizures. Prophylactic measures against the development of hyperuricemia should be undertaken before initiation of chemotherapy. Possible interventions include discontinuing medications that increase serum urate levels or produce acidic urine (e.g., thiazides and salicylates); administration of fluids with sodium bicarbonate as an additive to IV solutions to promote hydration and alkalinization of the urine to a pH greater than 7; administration of allopurinol 1 to 2 days before chemotherapy; monitoring of serum electrolyte, uric acid, phosphorus, calcium, and creatinine levels; and monitoring for ureteral obstruction by urate calculi using computed tomography or ultrasound studies. Possible interventions for advanced renal insufficiency and subsequent chronic kidney disease may include peritoneal dialysis or hemodialysis.

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