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Postgraduate Education Corner: PULMONARY AND CRITICAL CARE PEARLS |

An 81-Year-Old Man With Lactic Acidosis, Refractory Hypoglycemia, and Lymphocytosis*

Khalil Diab, MD; Kenneth S. Knox, MD, FCCP; Chadi A. Hage, MD, FCCP
Author and Funding Information

*From Department of Medicine, Pulmonary and Critical Care Medicine (Drs. Diab and Knox), Indiana University; and Pulmonary-Critical Care and Infectious Diseases (Dr. Hage), Roudebush VA Medical Center, Indianapolis, IN.

Correspondence to: Chadi Hage, MD, FCCP, Assistant Professor of Medicine, Pulmonary-Critical Care and Infectious Diseases, Roudebush VA Medical Center and Indiana University, 1481 W Tenth St, 111P-IU, Indianapolis, IN 46202; e-mail: chage@iupui.edu



Chest. 2008;133(1):306-310. doi:10.1378/chest.07-1130
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An 81-year-old man was admitted to our hospital for refractory hypoglycemia, metabolic acidosis, unexplained lymphocytosis, and significant weight loss. The patient was known to have non–insulin-dependent diabetes mellitus, hypertension, and hypothyroidism. His medications included glyburide, atenolol, and levothyroxine. He presented to his primary care physician 2 weeks prior to presentation with hypoglycemic episodes. His glyburide was stopped; however, the hypoglycemic episodes persisted.

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