Hospitalized lithium overdose cases reported to theCalifornia Poison Control System

Offerman, Steven R.; Alsop, Judith A.; Lee, Joyoung; Holmes, James F.

doi:10.3109/15563650.2010.482533

Cited by 42 publications

(53 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The levels were drawn 12 h after admission and still would have been less than therapeutic if drawn immediately upon admission. Abnormal potassium concentrations have also been linked to arrhythmias associated with Li toxicity [2,4,[7][8][9]. Our patient had normal serum potassium levels throughout hospitalization.…”

Section: Discussionmentioning

confidence: 66%

“…Chronic exposures result in greater tissue loads, which may present with clinical toxicity [7]. Lithium's effect on cardiac conduction is still theoretical.…”

Section: Discussionmentioning

confidence: 99%

“…Lithium may interact or compete with other cations, such as sodium, potassium, calcium, and magnesium. Lithium exposure may reveal Brugada syndrome, suggesting that sodium channel blockade may be involved in sinus node dysfunction at toxic levels [7,12]. Ventricular tachycardia associated with Li toxicity is mentioned in the literature, yet actual case reports are rare and treatment is not established.…”

Section: Discussionmentioning

confidence: 99%

“…Clinical manifestations of chronic Li toxicity are primarily neurological; however, serious cardiac arrhythmias, generally bradyarrhythmias, have been reported [3][4][5][6][7][8]. Bradyarrhythmias occurring in a patient on Li should prompt testing for Li toxicity and associated electrolyte abnormalities [4].…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Hemodialysis Treatment of Monomorphic Ventricular Tachycardia Associated with Chronic Lithium Toxicity

2014

View full text Add to dashboard Cite

Introduction A patient with chronic lithium toxicity developed a life-threatening ventricular arrhythmia that resolved during removal of lithium by hemodialysis. Chronic lithium toxicity commonly results from diminished elimination and can produce neurotoxicity. Cardiovascular complications have been reported and generally affect the sinoatrial node and produce bradyarrhythmias. The majority of these arrhythmias require no emergent intervention. Ventricular arrhythmias associated with lithium toxicity are occasionally mentioned in the literature, but actual cases are rarely reported. Case Report A 74-year-old man was brought into the emergency department with a 3-day history of progressive encephalopathy, tremor, and weakness. The lithium level was elevated at 2.2 mmol/L, with a normal serum potassium. Electrocardiography revealed nonsustained monomorphic ventricular tachycardia (120-130 beats/min) lasting up to 1 min, alternating with sinus bradycardia and wandering atrial pacemaker. Episodes of monomorphic ventricular tachycardia recurred >100 times. The patient required a norepinephrine infusion for hypotension. Emergent hemodialysis was initiated to remove lithium and to treat the monomorphic ventricular tachycardia, which was felt to be secondary to lithium toxicity. Episodes of monomorphic ventricular tachycardia abated as hemodialysis progressed. The episodes resolved completely within 4 h of initiating hemodialysis. The patient was discharged home in sinus rhythm on day 5. Lithium was not reinstated. Conclusion Monomorphic ventricular tachycardia associated with chronic lithium toxicity is exceptionally rare. Hemodialysis is a treatment option.

show abstract

Section: Discussionmentioning

confidence: 66%

“…Chronic exposures result in greater tissue loads, which may present with clinical toxicity [7]. Lithium's effect on cardiac conduction is still theoretical.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Hemodialysis Treatment of Monomorphic Ventricular Tachycardia Associated with Chronic Lithium Toxicity

2014

View full text Add to dashboard Cite

show abstract

“…QT aralığında uzama, atriyoventriküler ileti gecikmesi, bradikardi gibi EKG anormallikleri de görülebilir. 2,6 Lityumun sinus nodundaki pacemakeri baskılaması nedeniyle lityum tedavisi bayılma episodları ile sonuçlanan, sinus disritmine neden olur. Bu nedenle bazı hastalarda sinus nod disfonksiyonu ve bizim olgumuzda olduğu gibi senkop gelişebilir.…”

Section: Discussionunclassified

Cardiac arrhythmias related lithium intoxication: Case report

Oğuztürk¹,

Turtay²,

Koca³

et al. 2011

Sakarya Med J

View full text Add to dashboard Cite

ÖzetLityum bipolar duygu durum bozukluklarının tedavi ve profilaksisinde en sık kullanılan ilaçtır. Serum düzeylerindeki küçük değişiklikler ciddi yan etkilere yol açarken terapötik aralıklardaki dozlar dahi toksik reaksiyonlara neden olabilir. Nörolojik, gastrointestinal yan etkiler gelişebilen lityum toksisitesinde kardiotoksik etkiye bağlı olarak da kardiak aritmiler oluşabilir. Biz acil servisimize nabız düşüklüğü ve senkop nedeniyle getirilen ön tanıda koroner arter hastalığı düşünülen, tetkikler sonrasında lityum alımına bağlı yavaş ventrikül cevaplı atriyal fibrilasyon olduğu anlaşılan bir olguyu sunduk. Sonuç olarak acil tıp doktorları lityum toksisitesi ile ilgili olarak her türlü aritminin olabileceği EKG değişiklikleri ve kardiak risk açısından uyanık olmalıdır. AbstractLithium is a drug that is used in management and prophylaxis of bipolar affective disorders most frequently. Relatively minor increases in serum concentrations may induce serious adverse effect, and concentrations within therapeutic range may result in toxic reactions. Neurological and gastrointestinal side effects can occur depending on the effect of lithium toxicity also cardiac arrhythmias may occur. We present the case of woman who had bradicardia syncope and developed slow ventriculer response atrial fibrillation related to intake of lithium overdose. As a result, the emergency physician should be vigilant to cardiac risks and ECG changes associated with lithium toxicity, including all kinds of arrhythmias. Çalışmamızda, lityum tedavisi almakta olan 70 yaşındaki bir bayan hastada gelişen yavaş ventrikül cevaplı atriyal fibrilasyon bildirilerek, bu ilacın aritmi oluşturucu etkisine dikkatleri çekmek amaçlanmıştır. Keywords

show abstract

Hemodialysis for lithium poisoning

Buchanan

2015

Cochrane Database of Systematic Reviews

View full text Add to dashboard Cite

BackgroundLithium salts, particularly lithium carbonate, are frequently used to treat bipolar disorder and mania. Lithium poisoning, which can occur as a result of reduced renal elimination, prescribing error, drug-drug interactions, or deliberate overdosage, produces neurologic injury that can be permanent. Hemodialysis is o en recommended to treat lithium poisoning. Although hemodialysis clearly enhances the elimination of lithium, it is unclear whether this translates into improved patient outcomes. Evidence from observational studies, generally of low methodological quality, shows similar outcomes in patients managed with or without the use of hemodialysis. ObjectivesTo determine whether hemodialysis, applied in addition to standard therapy, reduces the likelihood, severity, or duration of neurological sequelae following lithium poisoning. Search methodsWe ran the search on 15 May 2015. We searched the Cochrane Injuries Group's Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), MEDLINE (OvidSP), Embase Classic+Embase (OvidSP), CINAHL Plus, clinical trials registers and four other databases. We screened the reference lists of relevant studies, textbook chapters, and review articles, and performed a Google search to identify grey literature. Selection criteriaIn the context of this review, hemodialysis was defined as any extracorporeal technique to filter and extract toxicants from the serum, including all forms of hemodialysis, hemofiltration, and continuous renal replacement techniques, but not peritoneal dialysis. We included any clinical trials in which patients were randomly allocated to receive, or not receive, hemodialysis in addition to standard care for lithium poisoning. Data collection and analysisTwo authors reviewed the abstracts of all identified articles. If either author identified an article as potentially meeting the inclusion criteria, both authors reviewed the full text of the article. Main resultsNo randomized controlled trials of hemodialysis therapy for lithium poisoning were identified.

show abstract

Hospitalized lithium overdose cases reported to theCalifornia Poison Control System

Abstract: 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.

Cited by 42 publications

References 25 publications

Hemodialysis Treatment of Monomorphic Ventricular Tachycardia Associated with Chronic Lithium Toxicity

Hemodialysis Treatment of Monomorphic Ventricular Tachycardia Associated with Chronic Lithium Toxicity

Cardiac arrhythmias related lithium intoxication: Case report

Hemodialysis for lithium poisoning

Contact Info

Product

Resources

About