Geriatrics
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Case Reports
Lactic acidosis. Lactic acidosis associated with metformin use in treatment of type 2 diabetes mellitus.
Metformin, an antihyperglycemic, is widely used in the treatment of type 2 diabetes mellitus (DM). A rare, but important complication associated with this drug is the development of lactic acidosis: Overall mortality of lactic acidosis is approximately 50%. ⋯ We recommend an aggressive treatment strategy of hemodialysis followed by peritoneal dialysis, continuous bicarbonate infusion, and tight glucose control. We review the cautions and contraindications of metformin use for the treatment of type 2 DM and report an educational plan for residents and staff instituted to improve drug complication awareness and reduce mortality.
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Chronic non-cancer pain is notoriously undertreated, especially when the source cannot be identified by objective testing. Effective treatment often requires a combination of pharmacologic and non-pharmacologic approaches. This article describes current medication management of chronic pain, with particular attention to opioids. ⋯ Regarding opioids, the article addresses concerns about addiction potential; distinguishes between addiction and physical dependency; details the role of tolerance to different effects of opioids; and discusses their safety. With appropriate dosing, vigilant management, and careful tapering, opioids are a safe and effective choice for pain management in older adults. Appropriate follow-up guidelines are presented.
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The Women's Health Initiative (WHI) was a randomized, double-blinded, placebo-controlled study that evaluated the benefits and risks of hormone replacement therapy (HRT) for healthy postmenopausal women. The results indicated that HRT: 1) does not confer cardiovascular or cognitive protection; 2) increases breast cancer risk in women with a uterus; 3) increases stroke risk in women with hysterectomy; and 4) does not improve overall quality of life. ⋯ Because the results were surprising in light of prior observational and animal research, the study generated enormous controversy as to how to use HRT. Our position is that long-term HRT is not appropriate for most postmenopausal women, but treatment should be individualized for each patient.