An 88-year-old man presented to the emergency department with episodic light-headedness and dizziness of 4 days’ duration without vertigo. He had experienced these symptoms 3 years earlier during an episode of hypoglycemia. His medical history included diabetes, hypertension, chronic renal insufficiency without proteinuria (estimated glomerular filtration rate [eGFR] by Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI] equation, 20 mL/min/1.73 m2), dyslipidemia, atrial fibrillation, and gout. Prior to arrival, multiple home capillary glucose measurements confirmed hypoglycemia of less than 3.9 mmol/L (reference range, 3.9-11.1 mmol/L). (To convert glucose from mmol/L to mg/dL, multiply by 18.) Medications included warfarin, atorvastatin, acarbose, metformin, gliclazide, valsartan, perindopril, and indapamide.
Raslan IA, McDonald EG, Lee TC. Missed Opportunities for DeprescriptionA Teachable Moment. JAMA Intern Med. Published online May 05, 2017. doi:10.1001/jamainternmed.2017.1435