Pyrazinamide has a high risk of which metabolic complication, especially in gout-prone patients?

• A. Hyperuricemia leading to gout flares.
• B. Hypouricemia.
• C. Hyperkalemia.
• D. Hyperglycemia.

Answer: (A)

The key idea is how pyrazinamide affects uric acid handling in the body. Pyrazinamide (and its metabolite pyrazinoic acid) interferes with the kidneys’ ability to excrete uric acid, leading to higher levels in the blood — hyperuricemia. When uric acid rises, crystals can form in joints, triggering gout flares. This is especially likely in patients who already have gout or are prone to elevated uric acid, hence the heightened risk in gout-prone individuals.

The other metabolic issues listed don’t fit pyrazinamide’s pattern: it doesn’t typically cause low uric acid, high potassium, or high blood sugar as a primary effect.