The correct answer is:

Glimepiride

Educational Objective:

Recognize that certain medications for diabetes should be avoided in patients with chronic kidney disease.

Key Point:

Glimepiride should be avoided in patients with chronic kidney disease because it can lead to hypoglycemia.

Explanation:

Glimepiride is a second-generation sulfonylurea whose half-life is prolonged in patients with CKD and is most likely the medication causing this patient’s hypoglycemia.

Metformin should not be given patients with advanced kidney disease, not because of the risk of hypoglycemia but because of concern for lactic acidosis. 

Repaglinide is a short-acting insulin secretagogue, is used especially in those with chronic kidney disease (CKD). It should be taken with meals to avoid hypoglycemia.

In this patient, given the need for a continuous infusion of dextrose to maintain an adequate blood glucose level, it is not likely that repaglinide can be implicated.

Sitagliptin is not known to cause hypoglycemia.

Acarbose inhibits the absorption of carbohydrates in the small intestine and no dosage adjustment is needed in patients with CKD.

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