The most commonly documented interventions made by pharmacists involved in the care of patients visiting the ED included provision of drug information, dosage adjustment recommendations, responses to questions from nursing staff, formulary interchanges, and suggestions regarding initiation of drug therapy. The potential cost avoidance attributable to the pharmacist interventions during the study period was over 1 million dollars.

Oral agents used for the management of type 2 diabetes mellitus include sulfonylureas, biguanides, thiazolidinediones, metglitinides, and/or α -glucosidase inhibitors. These medication classes can be further classified as hypoglycemic and antihyperglycemic agents. Hypoglycemia is a major symptom of toxicity of these agents, particularly with the sulfonylureas, including combination medications that include sulfonylureas. In overdose situations, metformin, a biguanide, can lead to considerable gastrointestinal adverse effects and potentially lactic acidosis in severe cases. Data on the management of toxicities of the other classes are limited. This article will review the treatment modalities that have been used for treating symptomatic hypoglycemia and metformin-induced lactic acidosis.

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