Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Feb;8(1):53-56.
doi: 10.5811/cpcem.1442.

Lithium Toxicity: A Case Report of Toxicity Resulting in a Third-degree Heart Block

Samantha L Gaetani  1 , Alexandra M Amaducci  2 , Derek Fikse  2 , Andrew L Koons  2
Affiliations

Lithium Toxicity: A Case Report of Toxicity Resulting in a Third-degree Heart Block

Samantha L Gaetani et al. Clin Pract Cases Emerg Med. 2024 Feb.

Abstract

Introduction: Lithium is a medication used to treat bipolar disorder. It has a narrow therapeutic index, which frequently causes toxicity in patients.

Case report: We present an unusual case of a 66-year-old female with a history of bipolar disorder on chronic lithium, who developed a third-degree heart block, encephalopathy, and acute renal failure because of lithium toxicity.

Conclusion: This case highlights a rare but life-threatening case of complete heart block in the setting of lithium toxicity. The patient was treated with hemodialysis and pacemaker placement.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: By the CPC-EM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. The authors disclosed none.

Figures

Image 1.
Image 1.
This electrocardiogram shows third-degree heart block at a rate of 33 beats per minute. There is QRS complex widening at 174 milliseconds (ms) with Right Bundle Branch Block and a prolonged QTc interval at 560 ms. (Normal QRS is 70–100 ms and normal QTc less than 450 ms for males and less than 470 ms for females). The p-waves (indicated by black arrows) do not line up with the QRS complexes, thus demonstrating a third-degree heart block.
Image 2.
Image 2.
Electrocardiogram after a permanent pacemaker was placed. Atrial-sensed ventricular-paced rhythm with occasional premature ventricular complexes at a rate of 82 beats per minute. There is a p-wave (black arrows) before every QRS complex with regular intervals, indicating the patient is no longer in third-degree heart block.
See this image and copyright information in PMC

References

    1. Won E, Kim YK. An oldie but goodie: lithium in the treatment of bipolar disorder through neuroprotective and neurotrophic mechanisms. Int J Mol Sci. 2017;18(12):2679. - PMC - PubMed
    1. West-Ward Pharmaceuticals . Lithium Carbonate. Highlights of Prescribing Information. 2018. Available at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/017812s033,018.... Accessed June 10, 2023.
    1. Wen J, Sawmiller D, Wheeldon B, et al. A Review for lithium: pharmacokinetics, drug design, and toxicity. CNS Neurol Disord Drug Targets. 2019;18(10):769–78. - PubMed
    1. Anderson IB, Benowitz NL, Blanc PD, et al. Poisoning & Drug Overdose (293-5). Olson K. ed. 7th ed. San Francisco, CA: McGraw Hill Education; 2018.
    1. Baird-Gunning J, Lea-Henry T, Hoegberg LCG, et al. Lithium poisoning. J Intensive Care Med. 2017;32(4):249–63. - PubMed