An 87-year-old man with hypertension, diabetic nephropathy, and heart failure with preserved ejection fraction was brought to the emergency department (ED) for progressive weakness with lethargy for the past 3 days. His medication included atenolol, perindopril, torsemide, amlodipine, atorvastatin, sitagliptin, and basal insulin. Spironolactone was added to this regimen 2 weeks ago in the setting of clinical congestion. On arrival at the ED, he was bradycardic, at 53 beats/min. Capillary blood glucose level was elevated, at 14 mmol/L.
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