Cibenzoline intoxication: Effect of combined hemoperfusion-hemodialysis on plasma clearance

Roel Meeus Departments of Critical Care Medicine, University Hospital of Antwerp,

Gert A. Verpooten Department of Nephrology, University Hospital of Antwerp, Edegem, Belgium

Rudi De Paep Departments of Critical Care Medicine, University Hospital of Antwerp,

Bernard P. Paelinck Department of Cardiology, University Hospital of Antwerp, Edegem, Belgium

Hugo Neels Belgium Laboratory of Toxicology, University of Antwerp and ZNA Stuivenberg, Antwerp, Belgium

Sarah Cooreman Belgium Laboratory of Toxicology, University of Antwerp and ZNA Stuivenberg, Antwerp, Belgium

Mireille De Doncker Belgium Laboratory of Toxicology, University of Antwerp and ZNA Stuivenberg, Antwerp, Belgium

Philippe G. Jorens Departments of Critical Care Medicine, University Hospital of Antwerp,

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Abstract

Introduction. Cibenzoline is an antiarrhythmic drug used to treat patients with supraventricular or ventricular arrhythmias. Cibenzoline overdose is associated with proarrhythmic and hemodynamic effects such as hypotension and congestive heart failure. Case Report. We report a case of cardiogenic shock due to cibenzoline overdose in a patient with progressive renal insufficiency. Discussion. The standard treatment of a cibenzoline intoxication is symptomatic, but we used combined hemoperfusion-hemodialysis to treat our patient. Conclusions. This was associated with a rapid decline in plasma cibenzoline concentration and improvement of the clinical condition. However, only 28.98 mg of an estimated body pool of cibenzoline (447.2 to 806.6 mg) was removed during the 8 hours of treatment.

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