Lithium toxicity with rarely reported ECG manifestations

Area of Science:

• Nephrology
• Cardiology
• Clinical Toxicology

Background:

• Lithium is a common mood stabilizer, but overdose can lead to severe toxicity.
• Neurological symptoms are common in lithium intoxication, but cardiotoxicity is less frequently reported.
• Prompt recognition and management are crucial for favorable outcomes.

Observation:

• A patient with severe lithium intoxication presented with neurological symptoms.
• The patient also exhibited rare cardiotoxic effects: reversible first-degree atrioventricular (A-V) block, intraventricular conduction delay, and a prolonged Q-T interval.
• These cardiac manifestations were reversible with treatment.

Findings:

• Hemodialysis was a successful treatment modality for severe lithium intoxication.
• Lithium intoxication can manifest with significant and reversible cardiotoxicity, including A-V block and Q-T prolongation.
• The case underscores the importance of considering lithium toxicity in patients with overdose and ECG abnormalities.

Implications:

• Clinicians should consider lithium intoxication in the differential diagnosis of drug overdose, especially with prominent electrocardiogram (ECG) changes.
• Comprehensive monitoring, including cardiac assessment, is essential in managing lithium toxicity.
• This case contributes to the understanding of lithium's cardiotoxic potential and the efficacy of hemodialysis.