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Renal failure (RF) can reduce insulin requirements in patients with diabetes mellitus, causing more frequent hypoglycaemic events. Spontaneous hypoglycaemia is recognised in patients with severe renal impairment who do not have diabetes mellitus; its aetiology is multifactorial and includes drug toxicity. Phenytoin toxicity is usually associated with hyperglycaemia, but there are cases where phenytoin was implicated in facilitating hypoglycaemia in patients with normal renal function. This report shows the potential effect of phenytoin in causing hypoglycaemia in RF patients.

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