Question

A 62-year-old male with a past medical history of type 2 diabetes mellitus and coronary artery disease is currently taking multiple medications including ASA, atenolol, isosorbide, glipizide, metformin, and rosiglitazone. He presents with a confirmed left lower lobe pneumonia on chest X-ray, along with low bicarbonate levels, high glucose levels, and high creatinine levels. Which of his medications should be immediately discontinued?

1) ASA
2) atenolol
3) isosorbide
4) glipizide
5) metformin
6) rosiglitazone

Answer 1

The medication that should be immediately discontinued is metformin, due to the risk of lactic acidosis in a patient with high creatinine levels, which suggests compromised renal function.

Step-by-step explanation:

The patient, who has a past medical history of type 2 diabetes mellitus and coronary artery disease, is currently experiencing low bicarbonate levels, high glucose levels, and high creatinine levels. Given these parameters, the medication that should be immediately discontinued is metformin.

Metformin is known to increase the risk of lactic acidosis, particularly in situations where renal function is compromised, indicated by the high creatinine levels. Lactic acidosis can further result in low bicarbonate levels as the body tries to compensate for the acid-base imbalance. However, due to the complexity of medication management and potential interactions, it's critical for the patient to consult with a healthcare provider before stopping or starting any medication.