Sinus bradycardia with haemodynamic compromise following lithium intoxication

Area of Science:

• Nephrology
• Cardiology
• Psychiatry

Background:

• Lithium is a primary treatment for bipolar disorder, but carries risks of toxicity.
• Cardiotoxicity, including sinus node dysfunction, is a rare but serious complication of lithium intoxication.
• Acute kidney injury can exacerbate lithium toxicity, increasing patient risk.

Observation:

• A case report details an adult male with acute kidney injury and high serum lithium levels.
• The patient presented with unstable sinus bradycardia and hypotension.
• Initial management involved inotropic support and transcutaneous pacing.

Findings:

• The patient's bradycardia and hypotension resolved with intravenous fluids.
• Improvement correlated with the resolution of acute kidney injury and decreasing serum lithium levels.
• This highlights the link between kidney function, lithium levels, and cardiac function.

Implications:

• Clinicians should maintain a high index of suspicion for lithium-induced cardiotoxicity, particularly in patients with kidney dysfunction.
• Early identification and management of elevated lithium levels and associated conditions like acute kidney injury are vital.
• Recognizing and treating sinus bradycardia in lithium-treated patients can prevent severe cardiovascular events.