I believe this blogs readers may be smarter than the author. I choose to give 5 doses of indomethacin 50 mg over 2 days. As you suggested, the creatinine did increase. The gout did get dramatically better.
After 2 days we switched to prednisone with no adverse effects.
I eschewed colchicine because I do not find it as effectively for serious gouty attacks. I dislike any medicine which has diarrhea as an endpoint.
Perhaps I made a mistake. The creatinine will decrease over the next few days.
I take the first guessing as prescient. Hats off to the many comments.
I felt it important to bring out this issue. I do not think the patient has suffered at all, but next time I will likely use prednisone in this situation.
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I think it is a good model you are showing in that you are so open in admitting about the mistake.
I still think the guy shot up meth in his room. I once had a patient get a ticket for smoking Mary J in his hospital room.
Did he think we wouldn’t smell it?
On a serious note, why not just give him a burst of steroids to begin with? If the plan was to give steroids anyway, the infections concerns must mostly be alleviated
If the patient had been in the early days of infection treatment I would have used NSAIDs too. Maybe not indomethacin though. I know some nephrologists who don’t get excited about a couple of days of NSAID use while others don’t like rheumatologists near their ward.