Two elderly, nondiabetic patients with uremia, one of whom had received on the preceding day one gram of carbutamide per os and the other one gram of tolbutamide intravenously, had severe, prolonged hypoglycemic reactions. The reaction lasted for six days in the former patient and was so severe that daily administration of glucose was necessary. The patient died from uremia thirteen days after taking the drug. The other patient was markedly hypoglycemic until his death three and one-half days later. A fairly large benign adrenocortical adenoma was found at autopsy in each patient.
The same agents were also administered once to four severely uremic patients, but no significant depression of the blood sugar level was elicited. The cause of the prolonged hypoglycemia in some subjects remains undetermined.