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K+ > 4.0
9%
21/245
Na+ > 140
4%
10/245
HCO3- > 30
10%
25/245
Glucose > 300
2%
4/245
Creatinine > 2.0
75%
183/245
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Metformin is absolutely contraindicated in patients with renal failure due to the risk of lactic acidosis. An elevated serum creatinine suggests a decrease in GFR and the presence of renal failure. Metformin is a drug in the biguanide class used to treat diabetes mellitus type II. Metformin treats hyperglycemia by inhibiting gluconeogenesis. Metformin carries no risk of hypoglycemia, but is known to occasionally cause lactic acidosis in patients with renal failure, liver dysfunction, CHF, alcoholism, and sepsis. Vecchio et al. reviews metformin-induced lactic acidosis. They report that metformin is overall a safe drug when correctly used but is associated with lactic acidosis in rare cases. The most common condition in which this condition occurs is with renal insufficiency. Recent evidence has called into question the significance of the risk of lactic acidosis while using metformin. According to an April 2012 Cochrane review by Salpeter et al., there is no evidence from comparative trials or from observational cohort studies that metformin is associated with an increased risk of lactic acidosis when compared to other anti-hyperglycemic treatments. Illustration A depicts the actions of metformin on the liver, adipose tissue, muscle and pancreas. Incorrect Answers: Answers 1-4: Hyperkalemia, hypernatremia, metabolic alkalosis, and hyperglycemia do not affect the physiology of metformin and are not a contraindication to its use.
4.4
(5)
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