Bitter Pills

A CLINICAL PROBLEM-SOLVING article by Yonatan Grad from Brigham and Women's Hospital, Boston.
A 60-year-old man presented to an urgent care clinic with fatigue of 1 month's duration and increasing frequency of urination, nighttime urination, and increasing thirst over the previous week. He had earlier been told that he had prediabetes and was now concerned that his symptoms reflected progression to diabetes mellitus.
The patient's medical history was notable for anxiety, depression, hypercholesterolemia, seasonal allergies, hypogonadism, and gastroesophageal reflux disease. Three months earlier, he had an upper respiratory tract infection that was treated with a 5-day course of azithromycin. His regular medications included full-strength aspirin (taken for its cardioprotective effect), diazepam, venlafaxine, atorvastatin, omeprazole, budesonide, St. John's wort, and testosterone gel. The patient drank two cups of coffee daily and two shots of whisky (also taken because of the patient's belief in its cardioprotective effect) each evening.
A normal blood glucose level and the absence of glycosuria indicated that the patient's presenting symptoms were not due to diabetes mellitus and elevated level of blood urea nitrogen and elevated creatinine level indicated recent kidney injury. The chain of events in this case underscores the aphorism that medications can at times be thought of as poisons with beneficial side effects. In this case, as in many others, the treatment for one disease is the cause of another.
An Interactive Medical Case related to this article is available at NEJM.org. [Original Article]

Notes

• glycosuria [glàikousjúəriə]
• underscore = accentuate, bring out, italicize, stress, underline, emphasize