— 藥理與非經腸給藥 · HARD · MCQ —
一位第二型糖尿病病人被開立二甲雙胍（metformin）。護理師應優先向醫師報告下列哪項臨床發現？
A client with type 2 diabetes mellitus is prescribed metformin. Which clinical finding should the nurse prioritize reporting to the provider?
- ASerum creatinine level of 2.1 mg/dL✓ 正解血清肌酸酐濃度為 2.1 mg/dL
- BOccasional nausea after taking the medication服藥後偶爾感到噁心
- CFasting blood glucose of 145 mg/dL空腹血糖為 145 mg/dL
- DMild diarrhea occurring after the first dose第一次服藥後出現輕微腹瀉
— Explanation · 中文詳解 —
Metformin 主要經由腎臟排泄，若腎功能受損（如肌酸酐升高），藥物在體內累積會大幅增加乳酸中毒（Lactic Acidosis）的致命風險。肌酸酐 2.1 mg/dL 代表腎功能顯著下降，必須調整劑量或停止用藥。
Metformin is primarily excreted by the kidneys. If renal function is impaired (such as elevated creatinine), the drug accumulates in the body and substantially increases the risk of lethal lactic acidosis. A creatinine of 2.1 mg/dL indicates significantly decreased renal function, and the dose must be adjusted or the drug discontinued.
✦ 台美臨床差異
台灣醫師對於長期服用 Metformin 的 CKD 病人監測較為頻繁，且常規會提醒病人在進行顯影劑檢查前需停藥。