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Old 09-18-2012
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Arrow Belindalimm Daily Questions: Pharmacology #1

A 33-year-old Caucasian male is coming to doctor because of abdominal pain, nausea and Tachycardia. He also experiences fatigue, puffiness of lower extremities for several days. He told you that he had sore throat, fever and experienced fatigue about two weeks ago, of which symptoms went away after appropriate antibiotics regimen. His medical history is obvious for Diabetes Mellitus for couples of months and has been undertaking a hypoglycemics. Urine analysis shows creatinine is 2.1 mg/dL, Urea nitrogen is 24 mg/dL and protein is 5.7 mg/dL. No other medical significance is reported. Which of the following mostly seems to happen in this patient?

A. Dark urine
B. Pulmonary edema
C. Hypoglycemia
D. Weight gain
E. Hyperventilation

Last edited by belindalimm; 09-18-2012 at 07:03 AM. Reason: Less of information
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Old 09-18-2012
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Default EE

A 33-year-old Caucasian male is coming to doctor because of abdominal pain, nausea and Tachycardia. He also experiences fatigue, puffiness of lower extremities for several days. He told you that he had sore throat, fever and experienced fatigue about two weeks ago, of which symptoms went away after appropriate antibiotics regimen. His medical history is obvious for Diabetes Mellitus for couples of months and has been undertaking a hypoglycemics. Urine analysis shows creatinine is 2.1 mg/dL, Urea nitrogen is 24 mg/dL and protein is 5.7 mg/dL. No other medical significance is reported. Which of the following mostly seems to happen in this patient?

A. Dark urine
B. Pulmonary edema
C. Hypoglycemia
D. Weight gain
E. Hyperventilation

lactic acidosis from metformin therapy---->compensatory hyperventilation
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Old 09-18-2012
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E?
Could it be Metformin (the hypoglycemic mentioned in stem) causing renal toxicity, as well as Lactic acidosis. The latter could result in compensatory hyperventilation?
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Old 09-19-2012
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Default Yes, the answer is E

Since the renal function test is abnormal with massive proteinemia and elevated BUN and creatinine, we can conclude the patient's kidney function is getting worse. At the meantime, we were told the diabetic history, because the disease onsets in the 33-year of age, we can assume it is diabetes mellitus type II. Metformin is often used to treat type II diabetes mellitus. Before administrating this drug, renal function should be concerned since it is contraindicated in patients with renal problems. In patient mentioned in question stem, metformin causes lactate acidosis which will be compensated by hyperventilation aiming to get rid of excess CO2.
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