Twinkle.. Twinkle.. Little Star~

Iqa, jangan tidur lepas maghrib.
Nanti mlm x blh tidur plak.
Kalau dah tak tidur malam, nanti esok mengantuk pulak dalam kelas kan?
Takkan laa nk tidur dlm klas lg kan? kan?
huhu..

Okay, kita recap blk ape 1 bnda br yg blaja dari attachment hari ni.
Patient saya ni DM tapi kena hypoglycemic attack sebab tak makan lepas makan ubat. huhu..
Lebih kurang sama seperti keadaan saya sepanjang hari di hospital dan case presentation tadi.. (Wuhuuu!~ Pening gle.. Mcm nak tumbang dah tadi~ Tak tahan tuh! Jawab soalan pun maen jawab je.. Tak ley nak pikir sgt..)

Lesson for today:

Metformin is contraindicated in patients with poor renal clearance because Metformin can cause lactic acidosis and lead to death.

Sedikit maklumat yg di copy dan paste dari sos cili dan sos tomato seperti Katzung dan Centre for Adverse Reactions Monitoring (CARM), Dunedin untuk memahami konsep ini:

"Lactic acidosis appears to result from biguanide (Metformin ni biguanide tau..) interference causing an increase in production and decrease in clearance of lactate leading to higher cellular lactate levels. Intracellular redox potential then shifts from aerobic to anaerobic metabolism A decrease in pyruvate carboxylase activity, the rate limiting enzyme in the formation of glucose from lactate, can also decrease hepatic metabolism of lactate."

Betol la kot sebab metformin can
1. reduce hepatic and renal gluconeogenesis.. pas2..
2. it slows the glucose absorption of glucose from GI with increased glucose to lactate conversion.. and then..
3. it causes stimulation of glycolysis in tissues
4. it reduces plasma glucagon level

Oleh itu, Biguanides are actually..

Contraindicated in patients with renal disease, alcoholism, hepatic disease, or conditions predisposing to tissue anoxia (eg: Chronic cardiopulmonary dysfunction) because of an increased risk of lactic acidosis induced by biguanide drugs in the presence of these diseases~

Okay?
Dah2.. Cukup satu je..
Sekadar untuk memastikan tak tidur lepas maghrib~

Jom study?