A 54- year old obese patient with type 2 diabetes mellitus and a history of alcoholism probably should not receive metformin because it can increase the risk of:
**Core Concept**
Metformin is a commonly used oral antidiabetic drug in the biguanide class, primarily used to treat type 2 diabetes mellitus. Its mechanism of action involves inhibiting hepatic gluconeogenesis and increasing insulin sensitivity. However, metformin is contraindicated in certain clinical scenarios due to its potential side effects.
**Why the Correct Answer is Right**
The correct answer is related to lactic acidosis, a rare but potentially life-threatening complication of metformin therapy. Metformin can increase the risk of lactic acidosis, particularly in patients with impaired renal function, heart failure, or those who consume excessive amounts of alcohol. The mechanism involves impaired lactate clearance due to reduced renal function, allowing lactate to accumulate in the bloodstream. This can lead to metabolic acidosis, which can be fatal if left untreated.
**Why Each Wrong Option is Incorrect**
**Option A:** Hypoglycemia - Metformin does not cause hypoglycemia; it is an oral antidiabetic agent that does not stimulate insulin release. Hypoglycemia is more commonly associated with sulfonylureas or insulin therapy.
**Option B:** Hyperkalemia - Metformin does not directly cause hyperkalemia; it is more commonly associated with ACE inhibitors, potassium-sparing diuretics, or other medications that affect potassium levels.
**Option C:** Pancreatitis - Metformin is not typically associated with pancreatitis; this complication is more commonly linked to other antidiabetic agents, such as pioglitazone or sulfonylureas.
**Clinical Pearl / High-Yield Fact**
It is essential to remember that metformin is contraindicated in patients with a history of significant renal impairment, heart failure, or those who consume excessive amounts of alcohol, as these factors increase the risk of lactic acidosis.
**Correct Answer:** C. Lactic acidosis