— 藥理與非經腸給藥 · MEDIUM · MCQ —
一位第二型糖尿病病人被開立二甲雙胍（Metformin）。在用藥評估時，護理師應優先考量下列哪項臨床發現？
A client with type 2 diabetes mellitus is prescribed metformin. Which assessment finding should the nurse prioritize during the medication review?
- ABlood glucose level of 180 mg/dL血糖值為180 mg/dL
- BHistory of weight gain有體重增加的病史
- CReports of mild diarrhea報告輕微腹瀉
- DSerum creatinine level of 2.1 mg/dL✓ 正解血清肌酸酐值為2.1 mg/dL
— Explanation · 中文詳解 —
Metformin 主要經由腎臟代謝。若血清肌酸酐（Creatinine）過高，代表腎功能不佳，藥物易在體內蓄積，導致致死性的乳酸中毒（Lactic Acidosis）。因此腎功能指標是此藥最關鍵的評估項目。
Metformin is primarily excreted by the kidneys, so renal function must be assessed before administration. An elevated serum creatinine level indicates renal impairment, which increases the risk of drug accumulation and potentially fatal lactic acidosis.
✦ 台美臨床差異
台灣醫院常針對腎功能不佳者要求停藥或減量，醫囑執行依據與美國相同。