title: [Myasthenia-like syndrome induced by cibenzoline overdose in a patient with chronic kidney disease].
abstract: A female in her late 60s with chronic kidney disease was admitted to the emergency department with complaints of dizziness four days prior to hospitalization. Cibenzoline (300 mg/day) was administered for atrial fibrillation, which was detected in an electrocardiogram. After three days, she experienced blepharoptosis and was admitted for suspected myasthenia gravis. However, the anti-acetylcholine receptor antibody and edrophonium tests were negative. On day four after hospitalization, she suffered from pneumonia with pleural effusion and she was put on a respirator for four days. From day 16 after hospitalization, she had diarrhea and her renal function worsened. At the same time, a gradual aggravation of right blepharoptosis, dull headache, weakness and difficulty in chewing were noted. She experienced dyspnea on day 31 after hospitalization. Chest X-ray film did not show a pneumonia shadow or pleural effusion, and arterial blood gases revealed hypercapnia; she was diagnosed as having CO2 narcosis due to respiratory muscle fatigue and was put on a respirator again. Myasthenia-like syndrome was suspected because of a probable overdose of cibenzoline and administration of cibenzoline was withdrawn. Her condition improved and she was taken off the respirator on day 35 after hospitalization. Repetitive stimulation of 5 Hz was applied to her right facial nerve along with evoked electromyogram(EMG) on days 2 and 11 after discontinuing cibenzoline. On day 2, the EMG showed a waning phenomenon, whereas no such phenomenon was seen on day 11. The blood concentration of cibenzoline immediately after withdrawal was extremely high (2448 ng/mL). When this drug is administered to a patient with chronic kidney disease, attention must be paid to the indication, dose, and manifestation of the possible side effects.
authors.affiliation: Department of Nephrology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Kawasaki
authors.forename: Kensei
authors.initials: K
authors.lastname: Yahata
authors.forename: Chinatsu
authors.initials: C
authors.lastname: Okamoto
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Imamaki
authors.forename: Koichi
authors.initials: K
authors.lastname: Seta
authors.forename: Akira
authors.initials: A
authors.lastname: Sugawara
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects*; D002908:Chronic Disease; D062787:Drug Overdose; D005260:Female; D006801:Humans; D007093:Imidazoles / Q000009:adverse effects*; D007674:Kidney Diseases / Q000150:complications*; D009157:Myasthenia Gravis / Q000139:chemically induced*
chemical_list: D000889:Anti-Arrhythmia Agents; D007093:Imidazoles; C032151:cifenline