Emergency Medicine, Kaiser Permanente South Sacramento, Sacramento, CA 95823, USA.
Clin Toxicol (Phila). 2010 Jun;48(5):443-8. doi: 10.3109/15563650.2010.482533.
Lithium overdose primarily results in neurologic toxicity; however, cardiac effects have also been reported. Our aim was to describe a large cohort of hospitalized lithium overdose patients. Specifically we were interested in reported cardiac complications, frequency of hemodialysis (HD), and mortality.
This is a retrospective, observational case series of admitted isolated lithium exposure cases reported to the California Poison Control System (CPCS) from 2003 through 2007. Reported lithium exposure cases were identified by a search of our CPCS database. Only those cases resulting in hospital admission were included in this study. Cases with concomitant toxic exposures were excluded. Primary outcome variables were reported cardiac complications (defined as bradycardia with a heart rate < or =50 bpm, atrioventricular (AV) block, ventricular tachycardia, and ventricular fibrillation), administration of cardiovascular intervention (resuscitation, vasopressor medications, or cardiac pacing), and death.
In the 5-year-study period 629 lithium cases were reported to the CPCS and 502 hospitalized cases were included in this study. There were 44 [8.8%; 95% confidence intervals (CI) 6.3, 11.2] cases of acute lithium exposure, 124 (24.7%; 95% CI 20.9, 28.5) cases of acute on chronic (AC) overdose, and 282 (56.2%; 95% CI 51.8, 60.5) cases of chronic overdose. Sixty-nine patients received hemodialysis. This includes 6 (13.6%) acute, 12 (9.7%) AC, and 45 (16.0%) chronic cases. There were four deaths (0.8%, 95% CI 0.2, 1.6). Cardiac complications were reported in 29 cases (5.7%, 95% CI 3.7, 7.7%) with 18 of these cases (18/29; 62%) being isolated bradycardias (without hypotension). Only seven patients with reported cardiac complication (7/29; 24.1%; 95% CI = 8.6, 39.7) required cardiovascular intervention and all of these were cases of chronic lithium toxicity. Two bradycardic arrests occurred in chronic lithium exposure cases, including one who died.
In this cohort of hospitalized lithium exposure patients, death was rare. Reported cardiac complications were unusual with instances requiring cardiovascular intervention occurring only in cases of chronic lithium overdose. The majority of lithium toxicity cases were managed without HD.
锂过量主要导致神经毒性；然而，也有报道称其会影响心脏。我们的目的是描述一组大量的住院锂过量患者。具体来说，我们对报告的心脏并发症、血液透析（HD）的频率和死亡率感兴趣。
这是一项回顾性、观察性的病例系列研究，对 2003 年至 2007 年向加利福尼亚毒物控制系统（CPCS）报告的住院孤立锂暴露病例进行了描述。通过对我们的 CPCS 数据库进行搜索，确定了报告的锂暴露病例。仅纳入导致住院的病例。排除了同时存在有毒物质暴露的病例。主要观察结果变量为报告的心脏并发症（定义为心率<或=50 次/分的心动过缓、房室（AV）阻滞、室性心动过速和心室颤动）、心血管干预（复苏、血管加压药物或心脏起搏）的实施情况和死亡。
在 5 年的研究期间，CPCS 共报告了 629 例锂病例，其中 502 例住院病例纳入本研究。44 例（8.8%；95%置信区间[CI]为 6.3%至 11.2%）为急性锂暴露，124 例（24.7%；95%CI 为 20.9%至 28.5%）为急性与慢性重叠（AC）过量，282 例（56.2%；95%CI 为 51.8%至 60.5%）为慢性过量。69 例患者接受了血液透析。这包括 6 例（13.6%）急性、12 例（9.7%）AC 和 45 例（16.0%）慢性病例。有 4 例死亡（0.8%；95%CI 为 0.2%至 1.6%）。报告了 29 例（5.7%；95%CI 为 3.7%至 7.7%）心脏并发症，其中 18 例（18/29；62%）为孤立性心动过缓（无低血压）。仅 7 例（7/29；24.1%；95%CI=8.6%至 39.7%）报告有心脏并发症的患者需要心血管干预，这些患者均为慢性锂毒性。在慢性锂暴露病例中发生了 2 例心动过缓性心搏骤停，其中 1 例死亡。
在本住院锂暴露患者队列中，死亡罕见。报告的心脏并发症罕见，需要心血管干预的病例仅发生在慢性锂过量患者中。大多数锂毒性病例无需血液透析即可得到治疗。
