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Harold E. Paulus, MD; Adam Coutts, MS; John J. Calabro, MD; James R. Klinenberg, MD

JAMA. 1970;211(2):277-281.

Abstract
When 16 automated blood chemistry examinations were routinely performed at the time of admission to a large Veterans Administration hospital, serum urate values greater than 7 mg/100 ml were found in 13.2% of 4,148 male patients. When 200 patients with hyperuricemia were studied in detail, the most common causes of urate elevation were azotemia (20%), acidosis (20%), and ingestion of diuretics (20%). Only 12% had a history of gout. Eighty percent (160 patients) did not require specific therapy; the remaining 20% either had gout or had sustained hyperuricemia (values above 9 mg/100 ml) which warranted drug treatment. These findings suggest that abnormal data generated by a routine laboratory screening program do not confirm a diagnosis or justify therapy, but merely represent a different type of "chief complaint" which must be carefully investigated before a diagnosis is made or therapy considered.

Author Affiliations
From the Rheumatology Section, Medical Service (Drs. Paulus and Calabro), and the Laboratory Service (Mr. Coutts), Wadsworth Hospital, Veterans Administration Center; and the Department of Medicine (Drs. Calabro and Klinenberg), UCLA School of Medicine, Los Angeles.

Footnotes
Reprint requests to Wadsworth Hospital, Veterans Administration Center, Los Angeles 90073 (Dr. Paulus).

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