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Sinus bradycardia with haemodynamic compromise following lithium intoxication
  1. Garrett Michael Snipes1,
  2. Adam Hafeez2,
  3. George Marek1 and
  4. David E Winchester2
  1. 1Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
  2. 2Department of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
  1. Correspondence to Dr Garrett Michael Snipes; garrett.snipes{at}medicine.ufl.edu

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.

  • psychiatry (drugs and medicines)
  • arrhythmias
  • poisoning
  • toxicology
  • drug interactions

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Footnotes

  • Twitter @GarrettSnipesMD

  • Contributors The authors have contributed sufficiently to the case and have met all criteria to be included as authors. GMS: conceptualisation, literature review, data curation, writing—original draft and writing—review and editing. AH: conceptualisation, writing—original draft and writing—review and editing. GM: conceptualisation, data curation and writing—original draft. DEW: writing—original draft and writing—review and editing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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