A patient who has been taking metformin (Glucophage) for a year is seen in the clinic and has all of the following laboratory results. Which result does the nurse report to the prescriber immediately?
a. Blood urea nitrogen (BUN) 38 mg/dL
b. Red blood cell (RBC) count 4.1 million/mm3
c. Random blood glucose level 135 mg/dL
d. Alkaline phosphatase 40 international units per liter
A
BUN levels are one measure of kidney health. The normal range is 10 to 20 mg/dL. An elevated BUN may indicate kidney problems or dehydration. Metformin can cause kidney problems, and the risk for lactic acidosis is increased in any patient taking metformin who has impairment of kidney function. The prescriber must be aware of the situation and explore the possibility of kidney impairment further. The drug may need to be changed to a different class of antidiabetic drug.
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