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Allopurinol during acute gout — GPhC CRA MCQ

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HardMusculoskeletal TherapeuticsAllopurinol during acute goutGPhC CRA

A malnourished patient with sepsis and renal impairment receives high-dose intravenous flucloxacillin plus regular therapeutic-dose paracetamol. They develop unexplained high-anion-gap metabolic acidosis with normal lactate and ketones. What should be suspected and acted on?

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Correct answer: A — Pyroglutamic acidosis from 5-oxoproline accumulation; urgently review the medicines and investigate the acid–base disorder

Option A is correct: concurrent flucloxacillin and paracetamol can produce high-anion-gap metabolic acidosis through 5-oxoproline, particularly with sepsis, malnutrition or renal impairment. Option D invents salicylate generation. Option E ignores the supplied normal ketones and worsens exposure. Option B misclassifies the anion gap and escalates the potential contributor. Option C invents an excipient poisoning and delays a time-critical review.

Reference: Flucloxacillin SmPC: https://www.medicines.org.uk/emc/product/12395/smpc