Metformin and glibenclamide: comparative risks.

Abstract

Infusion of isoprenaline (1-2 ,fg/min) the next day resulted in mild improve- ment.Nevertheless, both feet gradually became gangrenous, and bilateral below knee amputations were performed six days after admission.CASE 2 A 28 year old housewife was admitted complaining of excrutiating pain in her feet.On examination her feet were pale and cold.Her hands were also cold but of normal colour.Her carotid, axillary, and femoral pulses were the only palpable peripheral pulses.She had suffered from migraine and duodenal ulceration for some years and had taken numerous drugs including propoxyphene, benzodiazepine derivatives, diclofenac, cimetidine, chlordiazepoxide, raubasine, sucralfate, ergotamine tartrate, and oxprenolol.The precise dosages and duration of these treatments could not be established, but we ascertained that she had been taking oxprenolol and ergotamine tartrate tablets for a considerable time before admission.Arteriography showed severe spasm of most parts of the femoral arteries, the distal parts of the brachial arteries, and the radial arteries.Intravenous infusion of heparin (500 units/hour) and dopamine (150-300 4g/min) resulted in moderate improvement in the circulation except in the left foot, which remained painful and developed a mottled appearance.A cannula was placed in the left femoral artery, and nitroglycerin (1 mg/hour) and heparin (500 units/hour) were infused.This caused a dramatic improvement.After 24 hours the peripheral pulses were palpable and the cannula was removed.Intravenous treatment was reduced over the next two days, and she made a satisfactory recovery.