Wednesday, May 25, 2011

Tales from Residency: Parameters

One day, the charge nurse dropped a chart down in front of me: "You forgot to write parameters for the Metformin."

Now usually you write parameters for blood pressure meds. Like if the patient's blood pressure is 75/30, you might not want them to get a medication that will lower their blood pressure. But Metformin is an oral medication for diabetes, which doesn't work immediately like insulin does but instead is effective over a longer period of time.

I didn't know how to react to this request. Finally I said, "I never write parameters for Metformin."

"Well, you should," she said.

I was exhausted and overwhelmed with work, as usual, and I actually tried for a second to think of a parameter I might write for Metformin. The only thing I could think of was: Hold if patient stops having diabetes. I almost said that. Instead, I just said, "Metformin doesn't cause hypoglycemia. I want the patient to get it no matter what."

Daring, huh?


  1. Bwahahahahaha. Ballsy. I like it.

  2. When I was asked about hold parameters for metformin, I honestly had no idea what to say because I didn't want to piss off the nurse.

  3. lactic acidosis?
    what did the nurse say after that?

  4. Hold if creatinine >1.5 in males, >1.4 in females, and before contrast studies?

  5. C+Todd, While those things are true, in the case I was referring to, they were looking for blood sugar parameters.

  6. Lol. I don't have anything against nurses or any other medical professionals that we interact with on a daily basis (in fact, we can't do our job without them - they're too valuable!); however, some of the things they bring up sometimes are down right funny or sad (or both).

  7. OMDG: You mean someone besides me got asked that stupid question?? Incredible.

    C: I can't remember, although I'm sure she looked very skeptical and thought I was endangering lives.

  8. Fizzy -- It's actually happened to me MORE THAN ONCE. One time, the nurse kept holding the metformin every time the blood sugars were below 100 without telling us. It took us a while to figure out WTH was actually going on.