Abstract
A 63-year-old male on chronic hemodialysis therapy since 1985 was admitted with coma in March 1993. The patient had been prescribed 150mg/day of cibenzoline for control of atrial fibrillation and ventricular premature beats from November 1992, and the dose had been reduced to 100mg/day in January 1993. Two months later (March 25, 1993), the patient suddenly lapsed into a coma and his plasma glucose level was less than 40mg/dl at that time. Intravenous glucose transfusion dramatically improved his consciousness level. The serum concentration of CZ was markedly increased to 973ng/ml, far beyond the therapeutic range (277-329ng/ml), so we discontinued CZ. Subsequently, his plasma glucose level was maintained within normal range. A hypoglycemic attack due to CZ has not previously been reported, as it has with Disopyramide (same class Ia drug, by Vaughan Williams classification). The course of the present case suggests that we should pay attention to the serum level of CZ and that patients on chronic hemodialysis are at risk for hypoglycemic attack.
