PT  - JOURNAL ARTICLE
AU  - Garrett Michael Snipes
AU  - Adam Hafeez
AU  - George Marek
AU  - David E Winchester
TI  - Sinus bradycardia with haemodynamic compromise following lithium intoxication
AID  - 10.1136/bcr-2021-242946
DP  - 2021 May 01
TA  - BMJ Case Reports
PG  - e242946
VI  - 14
IP  - 5
4099  - http://casereports.bmj.com/content/14/5/e242946.short
4100  - http://casereports.bmj.com/content/14/5/e242946.full
SO  - BMJ Case Reports2021 May 01; 14
AB  - 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.