Prolonged hypoglycemia was precipitated by acetohexamide in two patients with renal failure. In one case the hypoglycemia lasted eight days after withdrawal of the drug, representing the longest recorded such reaction to the sulfonylureas. The cause for the prolonged reactions in these two cases appeared to be the renal retention of acetohexamide metabolites possessing unaltered hypoglycemia potency. A classification of the pathogenesis of prolonged hypoglycemia secondary to sulfonylureas is given and related to the two reported patients.

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