Doctor prescribed 4000mg metformin. Did this cause my dehydration/renal failure 3 months later?
My doctor had me on Metformin 1000mg 2X daily, glyburide 10mg 2X daily, furosemide 80 mg daily, and Avandia 4mg daily. When Avandia began getting bad press, I asked him to take me off it and prescribe an alternative. He removed only the Avandia, and added Metaglip 5/500 2 tablets 2X a day. A few months later, I was rushed to the hospital in renal failure. I had been vomiting several times a week, but didn't realize that I was dehydrating. The kidney specialist said that I was at 15% kidney function. I was admitted and after 4 days of IV rehydration, they released me with insulin and Starlix and removed all other diabetic oral meds. Does anyone out there think that my doctor did me harm by having me on 4000mg daily of Metformin? This is what I have been told caused my dehydration-induced kidney failure. Thank you for any advice. My medical bills relating to this hospitalization have caused me financial hardship now, and I wonder if I didn't take proper care of myself, or maybe this might have been bad prescribing by the doctor. I often wonder if he meant to take me off the straight metformin pills when he added the additional 2000mg of metformin that is contained in the metaglip.
The maximum recommended dose of Metformin is 2550 mg per day. Metformin is not metabolized by the liver, but rather excreted by the kidneys and is also eliminated in the feces. It's usually not advisable to take more than 3 grams a day because of the risk of lactic acidosis and GI side effects. In an individual with normal kidney function and normal filtration rate, it's unlikely that 4 g of Metformin a day would cause acute renal failure (ARF) just by itself. Doses of over 63 g a day have been reported in the literature without lasting adverse effects. A larger dose of Metformin might cause GI upset, resulting in diarrhea and subsequent dehydration. You also mention that you are on Furosemide, which can cause dehydration as well. Over the counter NSAIDs, such as Ibuprofen, Aleve ect., are known to have adverse effect on kidney function. Dehydration can certainly precipitate ARF. In your case, it's probably a combination of different medications and their combined side effects on the kidney, rather than Metformin itself, that resulted in ARF.
OS, Nurse Practitioner
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