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. 2017;177(7):1028-1029. doi:10.1001/jamainternmed.2017.1435