---
title: An 88-year-old man with a history of diabetes, hypertension, and stage 4 chronic kidney disease
description: It's Kidney Disease Quiz Time with Med-Challenger!
---

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# [An 88-year-old man with a history of diabetes, hypertension, and stage 4 chronic kidney disease](https://challengercme.com/blog/an-88-year-old-man-with-a-history-of-diabetes-hypertension-and-stage-4-chronic-kidney-disease)

 Written by [Med-Challenger](https://challengercme.com/blog/author/med-challenger) | Jan 13, 2025 3:10:34 PM

An 88-year-old man with a history of diabetes, hypertension, and stage 4 chronic kidney disease presents with profound lethargy and periods of unresponsiveness. 

A blood glucose level obtained on admission to the emergency room was 40 mg/dL. Other laboratory findings included a creatinine level of 2.8 mg/dL and blood urea nitrogen of 48 mg/dL. 

The patient became alert and talkative following the administration of 10% dextrose but required a continuous infusion of dextrose during the first eight hours of observation to maintain a blood glucose level in the mid-80 mg/dL range. Neither the patient nor his family can provide his current medication list. 

Which of the following medications is the most likely cause of this patient’s symptoms?

- Metformin
- Sitagliptin
- Repaglinide
- Acarbose
- Glimepiride

 

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