I remember this eccentric endocrine MD who when consulted on patients in the hospital for either high or low blood sugars. He would come in, look at the chart, see the patient on Amaryl, see the trend of blood sugars dropping below 50 and flip out in the nurses station about Amaryl and Kidney function and how patients with increased creatinine should not even be on Amaryl– in fact he was so adamant that NO patient in the hospital should be on Amaryl. There are just to many variables affecting the blood glucose of sick patients, especially decreased kidney function as we load many of the patients with antibiotics and lasix and CT scan dye (not to mention the NPO status half of the time for testing)!
I thought at first he was just out-of-the-box, eccentric, passionate, teaching nurses in ways that seemed to me way over my head as I tried to understand his lectures, but really felt lost. The bottom line is that I remembered and learned : No AMARYL for impaired renal function and extreme caution if the attending family doctor is ordering amaryl in any of my patients.
So today here we go……. internal medicine doctor admits patient 5 days ago to tele. Cardio on consult for severe CHF, patient getting massive doses of lasix, BUN and Creat are rising and rising daily. Patient is taking the Amaryl. ooooooooops here we go….blood glucose 27–nurse gives an amp of dextrose–glucose goes up an hour later to 57–it is not enough! nurse calls internal medicine doctor and asks for IV fluids D10—MD says “No, I never have this problem at the nursing home but every time my patients are hospitalized you nurses are always calling me about this–feed the patient!” Nurse says that the patient is 90 years old and does not want to eat. Finally the MD “gives” in to D5%1/2 NSS at 100ml hour. Nurse is upset because the patient is in the hospital for CHF! Nurse is getting upset. Q 1 hour blood sugars are taken and the patients blood sugar is still below 60 and keeps dropping! Finally the nurse at her wits ends calls the House MD and a rapid response to treat the hypoglycemic cool, sweaty, confused patient and the patient gets the appropriate treatment. The patient had to transfer to ICU for q1 hour blood sugar checks and all the while I am thinking, ” This could of been avoided if the AMARYL was never ordered!”
Patient Advocacy: If you are not getting the treatment you need for your patient you have to go elsewhere.
I tried to look for a quick article on Amaryl and renal impairment and could not find one yet, but it does not matter: I SEE this happening again and again! I even heard it could take 3 days to get the medication out of the system if the kidneys are impaired so if your patient has a poor appetite, in kidney failure, and in the hospital: Don’t give the Amaryl! I would rather give the insulin with meals and chase the coverage then to go through that again!