case continues:
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Your patient has been stable for several months. Now, he presents with complaints of epigastric discomfort. Stool examination is positive for occult blood. Upper endoscopy is performed and a duodenal ulcer is noted. The patient is placed on cimetidine (Tagamet) 300 mg b.i.d.. His serum creatinine, which had been 2.6 mg/dL, rises in four days to 3.8 mg/dL.
What has happened? How could this problem be avoided? Can you suggest alternative treatment?