3) To recognize that polypharmacy issues are common and are not limited to a patient's own prescriptions. CASE INFORMATION: An 80 year old male on multiple medications presented with severe hypoglycemia. He had no prior history of diabetes and never used alcohol. During his initial hospitalization, the patient was found to be hypogonadal and diagnosed with cholangitis. Diagnosis was based on hypothermia, choledocholithiasis and ductal dilatation although blood cultures were negative and initially there was no leukocytosis. Cortisol levels were normal and no abdominal tumors were found by CT. Insulin levels and c-peptide levels were elevated. The patient's medications did not include any associated with hyperinsulinism. The patient's glucose normalized after two days of treatment with a glucose drip, antibiotics, and stone extraction with sphincterotomy. Upon discharge, the leading diagnosis was sepsis-induced hypoglycemia. The patient was rehospitalized five months later with another episode of hypoglycemia. A sulfonylurea level was sent and returned positive for glipizide. It was then discovered that the patient was erroneously taking his wife's glipizide. The patient has had no further episodes of hypoglycemia. IMPLICATIONS/DISCUSSION: The differential diagnosis of hypoglycemia includes hormone deficiencies, enzyme defects, acquired liver disease, malnutrition, sepsis, malignancy, medications, and hyperinsulinism. Hyperinsulinism can be caused by sepsis, insulinoma, autoantibodies and medications. These medications include exogenous insulin, sulfonylureas and other sulfa drugs, and also quinine and pentamidine. Hypoglycemia due to accidental oral sulfonylurea ingestion in non-diabetics is more common in the pediatric rather than the internal medicine literature. Drug-induced hypoglycemia should be considered whenever the patient has potential access to hypoglycemia-inducing agents. Polypharmacy is a wellrecognized cause of adverse drug events among the elderly. However, estimates of polypharmacy are limited to an individual's medications obtained by prescription or overthe-counter. It should be recognized that individuals with multiple medications may inadvertently consume medications other than their own.