コハク酸シベンゾリンにより遷延する低血糖症を来した維持透析患者の一例

Abstract

Cibenzoline succinate (Cibenzoline, CZ) may cause hypoglycemia as a side effect. Because CZ is mainly excreted by kidney, it is contraindicated in patients who are on hemodialysis. We experienced a case of prolonged hypoglycemia induced by CZ in a dialysis patient. He was prescribed CZ as medication to be taken as needed for palpitations related to atrial fibrillation attacks. Approximately 9 months later, he was brought to our hospital by ambulance due to chest oppression and general fatigue. He developed hypoglycemic coma on the third hospital day. The high serum concentration of immunoreactive insulin and serum C-peptide immunoreactivity suggested enhanced insulin secretion. The toxic plasma concentration of CZ (2,140 ng/ml) indicated that his hypoglycemic coma was induced by CZ. He needed intravenous hypertonic glucose injection for about 20 days to prevent the recurrence of hypoglycemia. The hypoglycemia induced by CZ may be prolonged over a few weeks in patients with reduced renal function, including patients on hemodialysis.