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Case Reports
. 2021 May 13;14(5):e242946.
doi: 10.1136/bcr-2021-242946.

Sinus bradycardia with haemodynamic compromise following lithium intoxication

Garrett Michael Snipes  1 , Adam Hafeez  2 , George Marek  3 , David E Winchester  2
Affiliations
Case Reports

Sinus bradycardia with haemodynamic compromise following lithium intoxication

Garrett Michael Snipes et al. BMJ Case Rep. .

Abstract

Lithium is a well-established treatment for mood disorders and considered first-line pharmacological therapy for bipolar disorder as per the American Psychiatric Association guidelines. However, lithium is associated with significant toxicity. Cardiotoxicity including sinus node dysfunction is a rare but clinically significant presentation of lithium intoxication. This case report describes an adult male presenting with unstable sinus bradycardia in the setting of acute kidney injury and elevated serum lithium levels. The patient required temporary management with inotropic support and transcutaneous pacing. The patient's heart rate and hypotension improved in parallel with resolution of his acute kidney injury and elevated serum lithium level after treatment with intravenous fluids. Given the prevalence of bradycardia in both the outpatient and inpatient settings, a high index of suspicion is necessary for the prevention and identification of this clinical entity to guide appropriate management.

Keywords: arrhythmias; drug interactions; poisoning; psychiatry (drugs and medicines); toxicology.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
ECG on presentation to the emergency department.
Figure 2
Figure 2
Baseline ECG.
Figure 3
Figure 3
Serum lithium and creatinine levels by hospital day.
See this image and copyright information in PMC

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