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inhibitors such as lisinopril. Many patients cannot tolerate the dry cough and must be switched to an angiotensin II receptor blocker (ARB) for the management of congestive heart failure.
Explanation• Metformin puts a patient at increased risk of renal failure when combined with a contrast medium. Metformin should be withheld 48 hours before and after all procedures.• Lactic acidosis is also a potential effect of metformin overdose because lactate uptake by the liver is diminished.• Metformin rarely causes hypoglycemia because it does not stimulate insulin release, but decreases glucose production in the liver and glucose absorption in theGI tract. It also improves insulin sensitivity.• Metformin does not cause hyperglycemia.• Cirrhosis can lead to hepatic encephalopathy, but this would not be observed secondary to the liver injury from this acute overdose.