Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
Department of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, Florida, USA.
BMJ Case Rep. 2021 May 13;14(5):e242946. doi: 10.1136/bcr-2021-242946.
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.
锂是一种成熟的情绪障碍治疗方法，被美国精神病学协会指南视为双相情感障碍的一线药物治疗方法。然而，锂与显著的毒性有关。心脏毒性包括窦房结功能障碍，是锂中毒的一种罕见但具有临床意义的表现。本病例报告描述了一名成年男性，在急性肾损伤和血清锂水平升高的情况下，表现为不稳定窦性心动过缓。患者需要使用正性肌力支持和经皮起搏进行临时治疗。患者的心率和低血压与急性肾损伤和血清锂水平升高同时改善，在静脉补液治疗后得到了改善。鉴于在门诊和住院环境中均存在心动过缓的情况，需要高度怀疑这种临床实体的存在，以指导适当的管理。
