[A case of acute cibenzoline intoxication in a hemodialysis patient]

After taking cibenzoline (200 mg/day, p.o.) for 6 days, a 72-year-old man, who had been on hemodialysis for one year, complained of general fatigue, chest oppression and muscular weakness. These symptoms got worse after taking another tablet of cibenzoline on admission. We strongly suspected cibenzoline intoxication and stopped cibenzoline p.o. immediately. On the next early morning, he became comatose and QRS interval was markedly prolonged on the electrocardiogram. The plasma cibenzoline level was 3,248 ng/ml. After endotracheal intubation, the respiration was supported with a ventilator. We also started hemodiafiltration and his consciousness became clearer with the QRS interval shortening. He was weaned from the respirator 8 hours after hemodiafiltration started. Finally the concentration of plasma cibenzoline normalized to 210 ng/ml after 4 times hemodialysis. Because cibenzoline is mainly excreted by kidney, the plasma cibenzoline level should be followed carefully, when it is administered in patients with renal dysfunction.