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Januvia And Pancreatitis Risk

Drug Safety Developments

Drug Safety Developments

Written by: Heather Helmendach, Legal Assistant One of the popular classes of drugs for type 2 diabetes consists ofdipeptidyl peptidase-4 (DPP-4) inhibitors. ThisDPP-4 inhibitors class comprises the following drugs: Based on various studies and patient reports, these drugs have been associated with the following side effects: Myocardial Infarction (MI) / Heart Attack In my last article , I discussed the findings of a recent study conducted on three types of diabetes drugs: sodium-glucose cotransporter (SGLT-2) inhibitors,dipeptidyl peptidase (DPP-4) inhibitors, and incretin mimetics--also referred to as glucagon-like peptide (GLP-1) agonists. Researchers found that all three classes of drugs were effective in lowering blood sugar levelsamong type 2 diabetes patients. However, only two of the classes of diabetes drugs--SGLT-2 inhibitors and incretin mimetics--were shown to reduce the risk of death. Furthermore, DPP-4 inhibitors were no more effective at reducing the risk than a placebo or no treatment at all. This finding is particularly alarming given that type 2 diabetes is associated with higher risk of death due to heart attacks or strokes. In light of this information about the risks of DPP-4 diabetes drugs, one must wonder if other classes of type 2 diabetes drugs--which help reduce the risk of death--would be a better alternative. Otherwise put, taking DPP-4 diabetes drugs may not be worth the risks that accompany them. In April 2016, the FDA issued a Drug Safety Communication that warned of the increased risk of heart failure in patients taking Onglyza, Kombiglyze XR, Nesina, Kazano, and Oseni. Following that announcement, almost one hundred lawsuits were filed on behalf of patients taking Onglyza and Kombiglyze XR. These cases have been compiledin a multi-distr Continue reading >>

Fda Issues Caution For Januvia And Janumet For Acute Pancreatitis

Fda Issues Caution For Januvia And Janumet For Acute Pancreatitis

Home / Resources / Articles / FDA Issues Caution for Januvia and Janumet for Acute Pancreatitis FDA Issues Caution for Januvia and Janumet for Acute Pancreatitis U.S. health officials said on Friday they suspect Merck & Co., Inc.s blockbuster diabetes drug Januvia may be linked to serious cases of inflamed pancreas, but company officials disputed the connection. Sitagliptin, the first in a new class of diabetic drugs called dipeptidyl peptidase-4 (DPP-4) inhibitors, is approved as an adjunct to diet and exercise to improve glycemic control in adults with Type 2 diabetes mellitus. Additionally, the analysis found that 19 of the 88 reported cases (21%) of pancreatitis occurred within 30 days of starting sitagliptin or sitagliptin/metformin. Furthermore, 47 of the 88 cases (53%) resolved once sitagliptin was discontinued. It is important to note that 45 cases (51%) were associated with at least one other risk factor for developing pancreatitis, such as diabetes, obesity, high cholesterol and/or high triglycerides. Based on the temporal relationship of initiating sitagliptin or sitagliptin/metformin and development of acute pancreatitis in the reviewed cases, FDA believes there may be an association between these events. Because acute pancreatitis is associated with considerable morbidity and mortality, and early recognition is important in reducing adverse health outcomes, FDA is recommending revisions to the prescribing information to alert healthcare professionals to this potentially serious adverse drug event Because a number of patients developed the condition soon after taking Januvia, or related drug Janumet, and more than half saw it disappear after they stopped using it, FDA believes there may be an association with the drug. But Dr. John Amatruda, a Merck senior Continue reading >>

Januvia, Janumet To Note Pancreatitis Cases

Januvia, Janumet To Note Pancreatitis Cases

Januvia, Janumet to Note Pancreatitis Cases FDA Wants Reports of Acute Pancreatitis in Prescribing Information for Diabetes Drugs Januvia and Janumet Sept. 25, 2009 -- The FDA wants the maker of the type 2 diabetes drugs Januvia and Janumet to change the prescribing information to note reports of acute pancreatitis , a potentially life-threatening pancreas problem. The FDA today announced that it has gotten reports of 88 people taking those drugs who developed acute pancreatitis between Oct. 16, 2006, and Feb. 9, 2009. Those cases include two cases of hemorrhagic pancreatitis (inflammation of the pancreas with bleeding) or necrotizing pancreatitis (in which the inflamed pancreas destroys itself). Januvia and Janumet both include the active ingredient sitagliptin ; Janumet also includes another drug, metformin . Today's FDA announcement focuses only on sitagliptin. The FDA has this advice for patients taking Januvia or Janumet: Be aware that acute pancreatitis has been reported in patients using Januvia or Janumet. Pay close attention for any signs or symptoms of pancreatitis, such as nausea , vomiting , not eating, and persistent severe abdominal pain , which may radiate to the back. Promptly discuss any signs and symptoms of pancreatitis with a health care professional. Do not stop or change medicines that have been prescribed without first talking with a knowledgeable health care professional. The FDA has asked Merck, the drug company that makes Januvia and Janumet, to make the following changes to the drugs' prescribing information: Note the reports of acute pancreatitis, including the severe forms of hemorrhagic or necrotizing pancreatitis Recommend that health care professionals monitor patients carefully for signs of pancreatitis when starting patients on either Continue reading >>

Fda Investigates Safety Of Type 2 Diabetes Drugs Januvia And Byetta

Fda Investigates Safety Of Type 2 Diabetes Drugs Januvia And Byetta

FDA Investigates Safety Of Type 2 Diabetes Drugs Januvia And Byetta The U.S. Food and Drug Administration is investigating whether or not the Type 2 Diabetes drugs Januvia (from Merck) and Byetta (from Bristol-Myers Squibb) are associated with an increased risk of developing pancreatic cancer. Close to 25 million people in the United States have diabetes , costing the country an estimated $245 billion a year . There's been a huge rise in the number of treatment options over the last few years. Many patients have to take more than one drug to stabilize their blood sugar levels and insulin . However, the safety of all these new diabetes medications is still under thorough investigation, the FDA informs. Data from a report in JAMA's Internal Medicine indicated that patients who took the diabetes drugs Januvia and Byetta were at a much greater risk of developing pancreatitis compared to those who didn't. Januvia is an oral antihyperglycemic, it is either used alone or in combination with other oral antihyperglycemic agents, such as metmorfin. Byetta is a glucagon-like peptide-1 agonist administered twice a day as a subcutaneous injection. The FDA is looking at all the medications belonging to a class of drugs called incretin mimetics (which includes Victoza and others), which stimulate the production of insulin. Following the results of a study carried out last month that analyzed insurance records, Merck and Bristol were quick to state the safety of their drugs. Merck even said they found "no compelling evidence establishing a causal relationship" between Januvia and pancreatitis or pancreatic cancer . In 2007, the FDA added information to the labels of Byetta about its association with pancreatitis and in 2009 the agency did the same with Januvia and Janumet. "The FDA ha Continue reading >>

All About The Januvia And Victoza Pancreatic Cancer Lawsuits

All About The Januvia And Victoza Pancreatic Cancer Lawsuits

The federal court overseeing the nationwide Januvia and Victozia pancreatic cancer litigation appointed Mr. Kennerly to the “Plaintiffs’ Steering Committee,” the group of plaintiffs’ lawyers responsible for building the case against Merck, the manufacturer of Januvia and Janumet, and Novo Nordisk, the manufacturer of Victoza. I’ve written several posts going back to 2012 about the link between Januvia and pancreatic cancer. Below is an brief summary of the science behind the cases. As of January 2018, there are several different groups of Januvia lawsuits: a federal multidistrict litigation based in the federal court in San Diego, a state consolidated litigation in Los Angeles, and scattered lawsuits filed in other states. No jury trials have been held. Correspondingly, there have been no Januvia or Victoza lawsuit settlements: the drug companies still vehemently deny any responsibility, and the litigation is simply too new for any settlement discussions yet. I represent a wide variety of clients who developed pancreatic cancer after taking Januvia, clients on both sides of the country and everywhere in between, clients ranging in age from their forties to their eighties. Our law firm has filed Januvia and Victoza cases in all of the courts identified above, and we are continuing to file cases. We review cases free of charge, and we represent clients on a contingent fee. (That is, we pay all costs on the case, and only charge a fee if we recover compensation.) The Causes Of Pancreatic Cancer, And The Cancer’s Relationship To Diabetes If you’re reading this page, then likely you or someone you know was diagnosed with pancreatic cancer. You already know that the prognosis is typically poor, even with aggressive treatment. Pancreatic cancer is typically asymp Continue reading >>

Januvia Pancreatic Cancer

Januvia Pancreatic Cancer

Since its release in 2006, the diabetes drug Januvia has been used by millions of patients to control high blood sugar associated with type 2 diabetes. With sales of more than $4 billion last year and prescriptions in over 80 countries, Januvia is the best-selling drug for pharmaceutical giant Merck. Unfortunately, health experts with the FDA, American Medical Association and UCLA have now warned that diabetes medications like Januvia may be linked to pancreatitis, kidney failure and Januvia pancreatic cancer. Pancreatic cancer attacks the lining of the pancreas, an organ that aids in digestion and the metabolism of sugars. Because the disease is seldom detected early and can spread quickly, it often has a poor prognosis. As a result, it is a leading cause of cancer death. Some of the common symptoms of Januvia pancreatic cancer include: Jaundice (yellowing of the skin and eyes) If you have experienced any of these symptoms, it is important to speak with your doctor immediately. If you were diagnosed after taking Januvia, it is also important to learn about the substantial compensation that may be available from a defective drug injury claim. Lawyers are currently helping those affected file claims against Merck due to the companys failure to properly warn patients about the risks of Januvia pancreatic cancer. If you or a loved one have been diagnosed with pancreatic cancer after taking Januvia, it is important to speak with a lawyer about your legal rights as soon as possible. Contact us today. The FDA first warned that Januvia was associated with pancreatitis in 2009. However, records show that Merck had reason to know of these risks years before, and also delayed important testing ordered by the FDA in 2011 that may have uncovered the risks of Januvia pancreatic can Continue reading >>

Selected Safety Information

Selected Safety Information

JANUVIA is contraindicated in patients with a history of a serious hypersensitivity reaction to sitagliptin, such as anaphylaxis or angioedema. There have been postmarketing reports of acute pancreatitis, including fatal and nonfatal hemorrhagic or necrotizing pancreatitis, in patients taking JANUVIA. After initiating JANUVIA, observe patients carefully for signs and symptoms of pancreatitis. If pancreatitis is suspected, promptly discontinue JANUVIA and initiate appropriate management. It is unknown whether patients with a history of pancreatitis are at increased risk of developing pancreatitis while taking JANUVIA. An association between dipeptidyl peptidase-4 (DPP-4) inhibitor treatment and heart failure has been observed in cardiovascular outcomes trials for two other members of the DPP-4 inhibitor class. These trials evaluated patients with type 2 diabetes mellitus and atherosclerotic cardiovascular disease. Consider the risks and benefits of JANUVIA prior to initiating treatment in patients at risk for heart failure, such as those with a prior history of heart failure and a history of renal impairment, and observe these patients for signs and symptoms of heart failure during therapy. Advise patients of the characteristic symptoms of heart failure and to immediately report such symptoms. If heart failure develops, evaluate and manage according to current standards of care and consider discontinuation of JANUVIA. Assessment of renal function is recommended prior to initiating JANUVIA and periodically thereafter. A dosage adjustment is recommended in patients with moderate or severe renal impairment and in patients with end-stage renal disease requiring hemodialysis or peritoneal dialysis. Caution should be used to ensure that the correct dose of JANUVIA is prescrib Continue reading >>

Does Sitagliptin Increase The Risk Of Pancreatitis | Sepalika.com

Does Sitagliptin Increase The Risk Of Pancreatitis | Sepalika.com

Home / Type 2 Diabetes / Does Sitagliptin Therapy Increase The Risk of Pancreatitis? Does Sitagliptin Therapy Increase The Risk of Pancreatitis? While sitagliptin continues to earn billions of dollars for its manufacturers as a preeminent anti diabetic drug, it has a long list of side effects, both minor and major. Other than the increased risks of thyroid and pancreatic cancer, another major side effect of using the drug is pancreatitis or inflammation of the pancreas. Sitagliptin (and all other gliptins) are dipeptidyl peptidase IV (DPP-IV) inhibitors. It regulates blood sugar levels by prolonging the activity of certain hormones called incretin hormones. You can follow this link to understand how sitagliptin works . Earlier it was thought that the risk of developing pancreatitis was inherent in patients suffering from diabetes. Later it was found that patients who were taking the drug were more likely to suffer from pancreatitis than those taking any other medication. After assessing 88 cases of pancreatitis from sitagliptin use, reported between 2006 and 2009, the US FDA revised the prescribing information of the drug to include information about the risks of pancreatitis. The common side effects of sitagliptin include digestive issues like diarrhea, nausea and abdominal pain. Unfortunately, the symptoms of pancreatitis are also similar. So whether the patient is suffering from side effect of sitagliptin or from pancreatitis is difficult to say. When the pancreatitis is drug-induced, some patients also display an altered mental status. This is a result of the release of massive amounts of toxins from an inflamed pancreas. Another observation of serious concern came from a study in which a high fat diet was found to be a risk factor in sitagliptin-induced pancreatit Continue reading >>

Study Sees No Evidence Linking Diabetes Drugs With Pancreatic Cancer Webmd

Study Sees No Evidence Linking Diabetes Drugs With Pancreatic Cancer Webmd

WEDNESDAY, Feb. 26, 2014 (HealthDay News) -- There's no firm evidence that the type 2 diabetes medications known as incretin-based drugs cause pancreatitis or pancreatic cancer , U.S. and European health officials say. But it's too early to say there's definitely no link between the injectable drugs and pancreatitis or pancreatic cancer , according to the safety assessment by the U.S. Food and Drug Administration (FDA) and its counterpart overseas, the European Medicines Agency (EMA). "Both agencies agree that assertions concerning a causal association between incretin-based drugs and pancreatitis or pancreatic cancer , as expressed recently in the scientific literature and in the media, are inconsistent with the current data," states the report in the Feb. 27 issue of the New England Journal of Medicine. "The FDA and the EMA have not reached a final conclusion at this time regarding such a causal relationship." Incretin-based drugs are among the newest medications available to treat type 2 diabetes , a chronic condition characterized by high levels of sugar in the blood . Nearly 26 million people in the United States and 33 million in the European Union have diabetes , and type 2 is by far the most common type. There are two types of incretin-based medications: GLP-1 agonists and DPP-4 inhibitors. Examples of GLP-1 agonists include exenatide ( Byetta ) and liraglutide (Victoza). Exenatide , the first incretin-based drug approved by the FDA, was approved in 2005. Examples of DPP-4 inhibitors include sitagliptin ( Januvia ) and saxagliptin (Onglyza). Sitagliptin was the first DPP-4 inhibitor approved by the FDA, receiving consent in 2006. GLP-1 agonists slow stomach emptying and increase insulin secretion, which help keep blood sugar lower. They also suppress secretion Continue reading >>

The Risk Of Pancreatitis With Sitagliptin Therapy In Older Adults: A Population-based Cohort Study

The Risk Of Pancreatitis With Sitagliptin Therapy In Older Adults: A Population-based Cohort Study

The risk of pancreatitis with sitagliptin therapy in older adults: a population-based cohort study 1Department of Medicine, Western University, London, Ont. 2Institute for Clinical Evaluative Sciences, Toronto, Ont. 3Division of Endocrinology and Metabolism, Department of Medicine, Western University, London, Ont. 4Department of Epidemiology and Biostatistics, Western University, London, Ont. Kristin Clemens, kclemens2008{at}meds.uwo.ca Background The risk of pancreatitis with sitagliptin use in routine care remains to be established in older patients. We aimed to determine this risk in older adults who were newly prescribed sitagliptin versus an alternative hypoglycemic agent in the outpatient setting. Methods In a population-based retrospective cohort study in Ontario from 2010 until 2012 involving adults aged 66 years and older, we studied those who were newly prescribed sitagliptin or an alternative hypoglycemic agent. Our primary outcome of interest was a hospital encounter (emergency department visit or hospital admission) with acute pancreatitis within 90 days. We used inverse probability of treatment weighting to balance the 2 groups and logistic regression with a robust variance estimate to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Results A total of 57689 patients (mean age 74 yr) were newly prescribed sitagliptin, and 83405 patients (mean age 75 yr) were given an alternative hypoglycemic agent (metformin, glyburide, gliclazide or insulin) during the study period. After weighting, there were no significant differences in measured baseline characteristics between groups. In the weighted sample, sitagliptin was not associated with an increased risk of a hospital encounter with pancreatitis compared with alternative hypoglycemic agents (wei Continue reading >>

Januvia Taken Alone May Increase Pancreatic Risks, But Using It With Metformin Removes The Threat

Januvia Taken Alone May Increase Pancreatic Risks, But Using It With Metformin Removes The Threat

A study of Merck’s Januvia (sitagliptin), a drug for patients with type 2 diabetes, has found that its use can lead in some patients to a low-grade form of pancreatitis and an increased risk of pancreatic cancer in the long term. However, the study, conducted at the Larry L. Hillblom Islet Research Center at UCLA, also found that the risks associated with Januvia as a monotherapy are removed when the drug is used in conjunction with metformin (trade name Glucophage). Metformin, a low-cost drug that controls glucose production by the liver, is one of the oldest and most benign standbys in the anti-diabetes arsenal. The researchers found that Januvia caused pancreatic abnormalities that are established risk factors for pancreatitis and, in the long run, pancreatic cancer. The problem may derive from Januvia’s ability to spur the production-sometimes to exceptionally high levels-of cells that line the pancreatic ducts, which can lead to abnormalities. Januvia increases the effectiveness of a digestive hormone called glucagon-like peptide (GLP-1), which lowers blood sugar levels in type 2s. Concerns that it may induce problems with the pancreas call to mind recent suspicions by the FDA that Byetta, a similar drug, may have been a causative factor in several cases of severe pancreatitis that later led to death. In Byetta’s case, manufacturers Amylin and Eli Lilly have asserted that the FDA has not been able to show a direct connection between taking Byetta-which has over 600,000 users-and severe or fatal pancreatitis among a small group (30) of those users. The UCLA study’s determination that metformin mitigates Januvia’s ill effects is welcome news. The researchers found that the two drugs worked synergistically, preserving pancreatic beta cells and increasing ins Continue reading >>

Januvia, Byetta Double Pancreatitis Risk, Jama Analysis Finds

Januvia, Byetta Double Pancreatitis Risk, Jama Analysis Finds

Januvia, Byetta double pancreatitis risk, JAMA analysis finds The diabetes treatments Januvia and Byetta may double patients' risk of pancreatitis, a new study finds. The drugs, sold by Merck ($MRK) and a Bristol-Myers Squibb ($BMY)/AstraZeneca ($AZN) partnership, have been linked to pancreatitis before, but the JAMA Internal Medicine study puts a number to that risk for the first time. Researchers analyzed insurance records to find that patients hospitalized with pancreatitis were twice as likely to be using Januvia or Byetta, when compared with diabetics who didn't have pancreatitis, Bloomberg reports. "This is the first real study to give an estimate of what the risk is," said study author Sonal Singh, assistant professor at Johns Hopkins University. "[U]ntil now we just had a few case reports." It was on the basis of those case reports that the FDA issued safety alerts for both drugs. In 2007, the agency flagged pancreatitis cases in Byetta patients, and did the same for Januvia in 2009. In 2008, the FDA amped up label warnings on Byetta after 6 deaths in patients who had developed pancreatitis, though four of them couldn't be causally linked to the condition. Besides the risks of acute pancreatitis itself, the condition boosts the risk of pancreatic cancer. Both companies defended their drugs' safety. Merck told Bloomberg that it has reviewed the data and found "no compelling evidence of a causal relationship" between Januvia and pancreatitis or pancreatic cancer. Bristol-Myers said it and AstraZeneca are confident in the "positive benefit-risk profile" of Byetta and its long-lasting formulation Bydureon, and promised to "continue to carefully monitor" post-marketing reports. Merck's Januvia franchise is a whopper. The drug itself brought in $4 billion for Merck l Continue reading >>

Important Safety Information

Important Safety Information

WHAT IS JANUVIA®? JANUVIA (jah-NEW-vee-ah) is a once-daily prescription pill that, along with diet and exercise, helps lower blood sugar levels in adults with type 2 diabetes. JANUVIA should not be used in patients with type 1 diabetes or with diabetic ketoacidosis (increased ketones in the blood or urine). If you have had pancreatitis (inflammation of the pancreas), it is not known if you have a higher chance of getting it while taking JANUVIA. Serious side effects can happen in people who take JANUVIA, including pancreatitis, which may be severe and lead to death. Before you start taking JANUVIA, tell your doctor if you've ever had pancreatitis. Stop taking JANUVIA and call your doctor right away if you have pain in your stomach area (abdomen) that is severe and will not go away. The pain may be felt going from your abdomen through to your back. The pain may happen with or without vomiting. These may be symptoms of pancreatitis. Before you start taking JANUVIA, tell your doctor if you have ever had heart failure (your heart does not pump blood well enough) or have problems with your kidneys. Contact your doctor right away if you have increasing shortness of breath or trouble breathing (especially when you lie down); swelling or fluid retention (especially in the feet, ankles, or legs); an unusually fast increase in weight; or unusual tiredness. These may be symptoms of heart failure. Do not take JANUVIA if you are allergic to any of its ingredients, including sitagliptin. Symptoms of serious allergic reactions to JANUVIA, including rash, hives, and swelling of the face, lips, tongue, and throat that may cause difficulty breathing or swallowing, can occur. If you have any symptoms of a serious allergic reaction, stop taking JANUVIA and call your doctor right away. Kid Continue reading >>

Popular Diabetes Treatment Could Trigger Pancreatitis, Pancreatic Cancer, Study Suggests

Popular Diabetes Treatment Could Trigger Pancreatitis, Pancreatic Cancer, Study Suggests

Follow all of ScienceDaily's latest research news and top science headlines ! Popular Diabetes Treatment Could Trigger Pancreatitis, Pancreatic Cancer, Study Suggests A drug widely used to treat type 2 diabetes may have unintended effects on the pancreas that could lead to a form of low-grade pancreatitis in some patients and a greater risk of pancreatic cancer in long-term users. Sitagliptin, sold in pill form as Januvia, caused abnormalities in the pancreas that are recognized as risk factors for pancreatitis and, with time, pancreatic cancer in humans. A drug widely used to treat Type 2 diabetes may have unintended effects on the pancreas that could lead to a form of low-grade pancreatitis in some patients and a greater risk of pancreatic cancer in long-term users, UCLA researchers have found. Researchers from the Larry L. Hillblom Islet Research Center at UCLA found that sitagliptin, sold in pill form as Januvia, caused abnormalities in the pancreas that are recognized as risk factors for pancreatitis and, with time, pancreatic cancer in humans. Januvia is marketed by Merck & Co. Inc. Sitagliptin is a member of a new class of drugs that enhance the actions of the gut hormone known as glucagon-like peptide 1 (GLP-1), which has been shown to be effective in lowering blood sugar in people with Type 2 diabetes. "Type 2 diabetes is a lifelong disease people often take the same drugs for many years, so any adverse effect that could over time increase the risk for pancreatic cancer would be a concern," said Dr. Peter Butler, director of the Hillblom Center and the study's lead investigator. "A concern here is that the unwanted effects of this drug on the pancreas would likely not be detected in humans unless the pancreas was removed and examined." An observed connection b Continue reading >>

Sitagliptin-induced Pancreatitis – A Longer Road Than Expected

Sitagliptin-induced Pancreatitis – A Longer Road Than Expected

Go to: Case History/Exam Our patient is a 57-year-old African American female with a past medical history significant for type 2 diabetes mellitus, hypertension, gastro-esophageal reflux disease, and cholecystitis status post cholecystectomy thirty years prior to the presentation, who presented with 4 days of epigastric abdominal pain. The pain was sharp and stabbing, did not radiate, and was worse with eating. There were no associated fevers, chills, sweats, chest pain, shortness of breath, nausea, or vomiting, although the patient did report early satiety over the same time period. The patient denied any history of hyperlipidemia, hypercalcemia, recent travel, insect bites, trauma, alcohol or drug use. She also denied any prior episodes of pancreatitis. She was admitted to the hospital for cholecystitis in 1983, and her gallbladder was surgically removed at that time. Her medications on admission included sitagliptin 100 mg per os (PO) daily, glipizide XL 10 mg PO with breakfast, and glipizide XL 5 mg PO with dinner. The patient had been on sitagliptin for more than 3 years. Her last hemoglobin A1c was 9%. Other medications included lisinopril 20 mg PO daily and esomeprazole 40 mg PO daily. On admission, the patient's height, weight, and body mass index were 1.676 m, 114.76 kg, and 40.8 kg/m2, respectively. Her vital signs included a temperature of 37.4°C (99.3°F), blood pressure of 149/92 mmHg, heart rate of 114 beats/min, and oxygen saturation of 96% on room air. On exam, her abdomen was tender to palpation in the epigastrium without rebound, guarding or palpable masses. Her white blood cell count was 10.2 × 109/L (10200/μL), alanine aminotransferase 53 U/L, lipase 1129 U/L, and blood glucose 19.94 mmol/L (359 mg/dL). Her total cholesterol was 4.11 mmol/L (159 m Continue reading >>

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