A 57-year-old man was admitted to hospital with joint pains. He was found to have gout. He had been found to have type 2 diabetes mellitus at the age of 47 years and developed nephropathy 7 years later. He was taking metformin 1 g twice daily, ramipril 5 mg twice daily and gliclazide 80 mg twice daily. The admitting team advised him to take ibuprofen 400 mg three times daily as needed.
On examination, his pulse was 87 beats per minute and his blood pressure was 146/85 mmHg. He had an inflamed right hallux.
Investigations:
serum sodium131 mmol/L (137C144)
serum potassium5.1 mmol/L (3.5C4.9)
serum creatinine156 µmol/L (60C110)
estimated glomerular filtration rate (MDRD)42 mL/min/1.73 m2 (>60)
haemoglobin A1c72 mmol/mol (20C42)
random plasma glucose23.0 mmol/L
What is the most appropriate step in management?
A . stop gliclazide and ibuprofen
B . stop gliclazide and withhold metformin
C . stop ibuprofen alone
D . stop ibuprofen and withhold metformin
E . withhold metformin alone
Answer: D