A 62-year-old Type 2 diabetic patient presents with complaints of malaise, myalgias, respiratory distress, and increased somnolence. If laboratory examination reveals an anion gap of 26mmol/L, HCO3- of 17 mmol/L and an aerial blood pH of 7.27. You suspect lactic acidosis. The patient is most likely receiving which of the following?

Lactic acidosis, characterized by elevated blood lactate, decreased aerial blood pH, decreabicarbonate, and electrolyte imbalances with an elevated anion gap (normal = 10 - 12), is a rare but serious complication of metformin administration. The onset of lactic acidosis is usually accompanied by several non-specific signs and symptoms including malaise, myalgias, respiratory distress and increased somnolence. There may be associated hypothermia, hypotension, and resistant bradyarrhythmias as the condition progresses. Choice Glucagon is a polypeptide hormone produced by the alpha cells of the islets of Langerhans in the pancreas. It stimulates the conversion of glycogen to glucose in the liver. This hormone is available commercially to be administered in an intramuscular injection for the emergency treatment of severe hypoglycemia in diabetic patients when the administration of oral glucose is not possible. The most common adverse effects include pain at the site of the injection as well as hyperglycemia. Choice Glyburide is a sulfonylurea associated with the development of hypoglycemia and cholestatic jaundice (a rare complication). Miglitol (choice C) is an alpha-glucosidase inhibitor commonly associated with the development of abdominal discomfo and flatulence.