A nurse is caring for a 62-year-old client with diabetes who has a new prescription for metoclopramide (Reglan). Which of the following statements is true regarding metoclopramide (Reglan)? (Select All That Apply.)

A. Hypothyroidism: This is incorrect. The client is taking levothyroxine (Synthroid) to treat hypothyroidism, and the symptoms described (diarrhea, weight loss, palpitations, heat intolerance) are more likely associated with excess thyroid hormone, not a lack of it.

B. Thyrotoxicosis: This is correct. The symptoms the client is experiencing—diarrhea, weight loss, palpitations, and heat intolerance—are classic signs of thyrotoxicosis, which occurs when there is an excess of thyroid hormone, possibly due to overtreatment with levothyroxine. These symptoms indicate that the thyroid hormone dose might need adjustment.

C. Addison's Disease: This is incorrect. Addison's disease is characterized by insufficient production of adrenal hormones and would typically manifest with symptoms such as fatigue, hypotension, and hyperpigmentation, not diarrhea or heat intolerance.

D. Cushing's Disease: This is incorrect. Cushing's disease is caused by excess cortisol and would typically result in symptoms such as weight gain, high blood pressure, and a round "moon" face, rather than the symptoms described in the question.

A. Hyperglycemia: While metformin is used to manage blood glucose levels in clients with diabetes, its interaction with contrast dye does not directly lead to hyperglycemia. However, the risk for kidney injury, which can affect glucose regulation, is a concern.

B. Acute renal failure: This is correct. The combination of metformin and iodine-containing contrast dye increases the risk of acute renal failure, also known as contrast-induced nephropathy (CIN). This occurs because contrast agents can cause kidney damage, and metformin is excreted by the kidneys. If renal function is impaired, the buildup of metformin can lead to lactic acidosis.

C. Acute pancreatitis: While acute pancreatitis is a possible side effect of metformin in some individuals, the primary concern with iodine-containing contrast dye is renal failure, not pancreatitis.

D. Acute liver failure: Metformin is primarily metabolized by the kidneys, not the liver, and does not commonly cause liver failure. Renal failure is the more pressing concern with the use of contrast dye in clients taking metformin.