Protracted presyncope and profound bradycardia due to lithium toxicity

White, Bryan P.; Larry, John; Kantharia, Bharat K.

doi:10.1016/j.ijcard.2006.12.051

Cited by 16 publications

(10 citation statements)

References 3 publications

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“…QT aralığında uzama, atriyoventriküler ileti gecikmesi, bradikardi gibi EKG anormallikleri de görülebilir. 2,6 Lityumun sinus nodundaki pacemakeri baskılaması nedeniyle lityum tedavisi bayılma episodları ile sonuçlanan, sinus disritmine neden olur. Bu nedenle bazı hastalarda sinus nod disfonksiyonu ve bizim olgumuzda olduğu gibi senkop gelişebilir.…”

Section: Discussionunclassified

Cardiac arrhythmias related lithium intoxication: Case report

Oğuztürk¹,

Turtay²,

Koca³

et al. 2011

Sakarya Med J

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ÖzetLityum bipolar duygu durum bozukluklarının tedavi ve profilaksisinde en sık kullanılan ilaçtır. Serum düzeylerindeki küçük değişiklikler ciddi yan etkilere yol açarken terapötik aralıklardaki dozlar dahi toksik reaksiyonlara neden olabilir. Nörolojik, gastrointestinal yan etkiler gelişebilen lityum toksisitesinde kardiotoksik etkiye bağlı olarak da kardiak aritmiler oluşabilir. Biz acil servisimize nabız düşüklüğü ve senkop nedeniyle getirilen ön tanıda koroner arter hastalığı düşünülen, tetkikler sonrasında lityum alımına bağlı yavaş ventrikül cevaplı atriyal fibrilasyon olduğu anlaşılan bir olguyu sunduk. Sonuç olarak acil tıp doktorları lityum toksisitesi ile ilgili olarak her türlü aritminin olabileceği EKG değişiklikleri ve kardiak risk açısından uyanık olmalıdır. AbstractLithium is a drug that is used in management and prophylaxis of bipolar affective disorders most frequently. Relatively minor increases in serum concentrations may induce serious adverse effect, and concentrations within therapeutic range may result in toxic reactions. Neurological and gastrointestinal side effects can occur depending on the effect of lithium toxicity also cardiac arrhythmias may occur. We present the case of woman who had bradicardia syncope and developed slow ventriculer response atrial fibrillation related to intake of lithium overdose. As a result, the emergency physician should be vigilant to cardiac risks and ECG changes associated with lithium toxicity, including all kinds of arrhythmias. Çalışmamızda, lityum tedavisi almakta olan 70 yaşındaki bir bayan hastada gelişen yavaş ventrikül cevaplı atriyal fibrilasyon bildirilerek, bu ilacın aritmi oluşturucu etkisine dikkatleri çekmek amaçlanmıştır. Keywords

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Section: Discussionunclassified

Cardiac arrhythmias related lithium intoxication: Case report

Oğuztürk¹,

Turtay²,

Koca³

et al. 2011

Sakarya Med J

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“…These untoward effects are generally encountered in patients over 65 years of age with baseline EKG abnormalities, conduction abnormalities, use of renal toxic medications, and concomitant use of AV nodal blocking agents [8]. Severe cardiotoxic effects are rarely observed, although non-specific, clinically insignificant electrocardiographic changes may be seen (eg, T-wave flattening or inversion, U waves, ST-segment depression, or prolongation of the QT interval) [1].…”

Section: Discussionmentioning

confidence: 99%

Rarely seen cardiotoxicity of lithium overdose: Complete heart block

Serinken

Karcıoğlu

Korkmaz

2009

International Journal of Cardiology

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“…Although arrhythmias are rare, prolonged QTc intervals and bradycardia have been reported. 10 Whereas swallow-induced bradycardia has been described previously, provocation of this syndrome by lithium toxicity has not. Lithium exerts its actions through the alteration of sodium transport in neurons, which increases intraneuronal metabolism and reduces stores of catecholamines.…”

Section: Sectionmentioning

confidence: 99%

Clinical Reasoning: Heart to swallow

et al. 2016

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A 55-year-old woman was admitted to our intensive care department after intoxication with lithium. Her medical history was relevant for bipolar disorder for which she received medical treatment with lithium, haloperidol, and citalopram. In the week before admission, she had developed a clinical picture of gastroenteritis with diarrhea and vomiting, which resulted in dehydration and a marked deterioration in kidney function. During the last days before admission, she had become progressively lethargic and had developed dysarthria as well as postural tremors of the extremities. The tremors were coarse and irregular, most clearly present in the hands with a frequency of approximately 8 Hz. At admission, she opened her eyes spontaneously, localized pain, and showed normal verbal responses (E4M5V5). Physical examination showed severe dysarthria, ataxia, and no focal neurologic deficits. Reflexes were normal. Laboratory investigation revealed a de novo elevated creatinine level (220 mmol/L, normal 49-90) corresponding to an estimated glomerular filtration rate of 22 mL/min/1.73 m 2 (normal .60) and a lithium level that was 5.8 mmol/L (target value 0.6-0.8 mmol/L). ECG at admission was normal except for a prolonged QTc interval of 533 milliseconds (normal ,450).Questions for consideration:

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Protracted presyncope and profound bradycardia due to lithium toxicity

Cited by 16 publications

References 3 publications

Cardiac arrhythmias related lithium intoxication: Case report

Cardiac arrhythmias related lithium intoxication: Case report

Rarely seen cardiotoxicity of lithium overdose: Complete heart block

Clinical Reasoning: Heart to swallow

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