Definition

The medical term for high blood uric acid is hyperuricemia. The typical causes of this syndrome in children are genetic, metabolic, digestive, cancer, or pharmacological side effects.

Uric acid is an end product of purine metabolism, which involves the decomposition of purines, which are chemical compounds in the body and found in numerous foods. Typically observed in adults, hyperuricemia can be induced by a diet rich in purine-rich foods, including seafood and organ meats. Prolonged exposure to elevated uric acid levels can result in its crystallization and the subsequent development of gouty joint disorders.

However, the etiology of hyperuricemia differs in children, as gout is a highly uncommon complication of hyperuricemia. A study conducted in Japan investigated the prevalence of gout in children and discovered that the condition occurred in approximately 48 cases out of 696 thousand children, or 0.007% of the total.

Causes

The manifestation of elevated uric acid levels in infants is distinct from that of hyperuricemia in adults. The following medical conditions and diseases can result in hyperuricemia in children:

• Metabolic disorders
  Lesch-Nyhan syndrome and Kelley-Seegmiller syndrome are metabolic disorders that can lead to hyperuricemia, among other complications. Lesch-Nyhan syndrome is characterized by excessive accumulation of uric acid in the body. Kelley-Seegmiller syndrome is an enzyme deficit involved in purine metabolism, leading to elevated amounts of uric acid in the blood.

• Down Syndrome
  Down syndrome is the most prevalent congenital disability. The link between Down syndrome and high blood uric acid in children is still being studied. Down syndrome patients may have more purine-metabolizing enzymes, which raise blood uric acid to compensate for unbalanced chemical interactions.

• Congenital Heart Disease
  Children with congenital heart disease lack oxygen in their tissues. The body compensates by breaking down purine and raising blood uric acid levels. In addition, congenital heart disease patients use diuretic medicines, which can increase uric acid levels by reducing fluid buildup.

• Gastroenteritis
  Nausea, vomiting, and diarrhea are symptoms of gastroenteritis. Children with diarrhea and vomiting risk dehydration. In children with gastroenteritis, dehydration may produce hyperuricemia.

• Asthma Bronchial
  Asthma attacks are one cause of hyperuricemia in children, and blood uric acid levels can gauge the severity of bronchial asthma. A reduction in tissue oxygen may cause hyperuricemia in children with bronchial asthma.

Risk Factor

In addition to the disorders mentioned above, many risk factors can increase the risk of children experiencing hyperuricemia. Common risk factors associated with hyperuricemia in children include:

• Family medical background with hyperuricemia or gout
• Possessing a genetic disorder that impacts the process of purine metabolism
• High consumption of purines from dietary sources, such as beef, shellfish, organ meats, and alcohol
• Neoplasms and hematological diseases, such as leukemia
• Uncontrolled renal disease
• Various medications, including specific diuretics and anti-seizure treatments, can potentially cause adverse effects of hyperuricemia.
• Insulin resistance leads to elevated blood sugar levels.
• Dyslipidemia refers to an abnormality in the body's cholesterol and triglyceride fats.
• Hypertension, often known as high blood pressure,
• Metabolic syndrome
• Obesity

Symptoms

The manifestations of hyperuricemia may be asymptomatic. In general, the manifest symptoms align with the afflicted disease's etiology. For instance, in the case of a child afflicted with gout or arthritis, both precipitated by elevated uric acid levels in the bloodstream, the child might manifest symptoms including joint pain, stiffness, and edema. Several children may also develop headaches, fatigue, and nausea as additional symptoms.

Diagnosis

The diagnosis of hyperuricemia in minors can be established through the use of blood tests that quantify uric acid concentrations. The term for this category of blood analysis is "serum uric acid test."

The average amount of uric acid in children may vary depending on age and gender but typically remains below 6 mg/dL. If the test findings indicate elevated uric acid levels, the doctor may undertake additional measures to ascertain the presence of hyperuricemia in the children.

Management

If elevated uric acid levels are detected in the bloodstream following a medical illness that includes hyperuricemia as one of its manifestations, the treatment will primarily target the underlying medical problem. Treatment options for hyperuricemia include the following:

1. To decrease uric acid synthesis in the body, the doctor may suggest dietary modifications that limit the intake of purine-rich foods, such as seafood and red meat.
2. Allopurinol is a medication that inhibits the generation of uric acid in the body, thereby preventing the creation of urate crystals in the joints.
3. Physiotherapy is a viable treatment option for children who suffer from joint issues caused by the accumulation of uric acid crystals. It aids in preserving joint strength and flexibility while preventing additional damage to the joints.
4. Maintain optimal body weight to alleviate strain on joints and mitigate the risk of joint injury.
5. Children with persistent hyperuricemia may require prolonged medication to manage blood uric acid levels and mitigate the risk of joint injury.

It is essential to remember that the dosage of hyperuricemia medicine being administered to children must be set by the treating physician and can differ from child to child. It is the responsibility of the physician to alter the dosage of the treatment by the child's current state of health and the degree of hyperuricemia that he is experiencing.

Complications

Uric acid can accumulate and cause difficulties if uric acid levels in the blood are allowed to remain high. The formation of uric acid crystals in the joints or uric acid stones in the kidneys is a potential consequence of uric acid.

Prevention

The American Academy of Pediatrics (AAP) recommends the following 5 prevention strategies to decrease high levels of uric acid in children's blood:

1. To avoid elevated uric acid levels in the bloodstream, it is advisable to regulate your consumption of purine-rich foods, such as red meat, seafood, and alcohol.
2. Maintaining a healthy body weight is important, as excessive weight is typically linked to bad dietary habits, including purine-rich foods. In addition, excessive weight might elevate the likelihood of developing hyperuricemia; thus, maintaining a healthy body weight can be a preventive measure against hyperuricemia.
3. Children must engage in regular and dedicated physical activity to preserve healthy joint tissue and avoid the development of urate crystals in the joints.
4. Regularly monitor the levels of uric acid in children who have a family history of hyperuricemia or are at high risk.
5. If a child is already diagnosed with hyperuricemia, a physician may advise medical intervention to decrease the amounts of uric acid in the bloodstream and mitigate potential problems.

When to See a Doctor?

According to the American Academy of Pediatrics (AAP), children with hyperuricemia should seek medical advice if they exhibit persistent joint discomfort, swelling, or fever. Additionally, certain children may encounter symptoms such as headaches, lethargy, or nausea.

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