Cargando…
Lithium intoxication presenting as altered consciousness and arrhythmia with cardiogenic shock: A case report
RATIONALE: Lithium has been used to treat bipolar disorder. Lithium has a narrow therapeutic index, with a therapeutic level between 0.6 and 1.5 mEq/L. The possible complications of lithium overdose include altered mental status, hand tremor, muscle weakness, nausea, vomiting, diarrhea, seizure, syn...
Autores principales: | , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wolters Kluwer Health
2018
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6250446/ https://www.ncbi.nlm.nih.gov/pubmed/30407335 http://dx.doi.org/10.1097/MD.0000000000013129 |
_version_ | 1783372913231003648 |
---|---|
author | Chien, Shun-Ching Liu, Kuan-Ting Wu, Yen-Hung |
author_facet | Chien, Shun-Ching Liu, Kuan-Ting Wu, Yen-Hung |
author_sort | Chien, Shun-Ching |
collection | PubMed |
description | RATIONALE: Lithium has been used to treat bipolar disorder. Lithium has a narrow therapeutic index, with a therapeutic level between 0.6 and 1.5 mEq/L. The possible complications of lithium overdose include altered mental status, hand tremor, muscle weakness, nausea, vomiting, diarrhea, seizure, syncope, and arrhythmia. Lithium intoxication can be fatal and is difficult to diagnose in patients without a history of lithium intake. The occurrence of serious cardiac arrhythmias is rare in lithium intoxication. PATIENT CONCERNS: An 81-year-old man was brought to the emergency department because of consciousness disturbance for 2 days. According to his daughter, he had a history of hypertension and diabetes. Recently, his family also observed slurring of speech and easy choking. The physical examination findings were unremarkable. DIAGNOSIS: Blood examination only revealed impaired renal function. Twelve-lead electrocardiography revealed sinus rhythm with first-degree atrioventricular block. Chest radiography revealed mediastinal widening. The blood pressures obtained from the 4 limbs showed no significant differences. Subsequently, brain computed tomography revealed no obvious intracranial lesion. A neurologist was consulted, and a recent ischemic stroke could not be ruled out. While in the observation area, his systolic blood pressure decreased to <90 mm Hg and he showed bradycardia, and 12-lead electrocardiography revealed an AV block and long pulse. Contrast-enhanced chest computed tomography revealed no evidence of aortic dissection. Another family member reported a history of lithium intake for bipolar disorder for >30 years. Blood examination revealed a lithium concentration of 2.65 mEq/L. INTERVENTIONS: A nephrologist was consulted, and emergency hemodialysis was indicated. Dopamine was administered for his shock status via a right neck central venous catheter. OUTCOMES: His lithium level gradually declined after the hemodialysis, and blood pressure and consciousness level improved subsequently. The patient was discharged 9 days later in a stable condition. LESSONS: If an emergency physician encounters a patient with altered consciousness and arrhythmia with cardiogenic shock, the patient's drug intake history should be carefully reviewed to rule out cardiovascular problems on the basis of the patient's clinical condition. |
format | Online Article Text |
id | pubmed-6250446 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Wolters Kluwer Health |
record_format | MEDLINE/PubMed |
spelling | pubmed-62504462018-12-10 Lithium intoxication presenting as altered consciousness and arrhythmia with cardiogenic shock: A case report Chien, Shun-Ching Liu, Kuan-Ting Wu, Yen-Hung Medicine (Baltimore) Research Article RATIONALE: Lithium has been used to treat bipolar disorder. Lithium has a narrow therapeutic index, with a therapeutic level between 0.6 and 1.5 mEq/L. The possible complications of lithium overdose include altered mental status, hand tremor, muscle weakness, nausea, vomiting, diarrhea, seizure, syncope, and arrhythmia. Lithium intoxication can be fatal and is difficult to diagnose in patients without a history of lithium intake. The occurrence of serious cardiac arrhythmias is rare in lithium intoxication. PATIENT CONCERNS: An 81-year-old man was brought to the emergency department because of consciousness disturbance for 2 days. According to his daughter, he had a history of hypertension and diabetes. Recently, his family also observed slurring of speech and easy choking. The physical examination findings were unremarkable. DIAGNOSIS: Blood examination only revealed impaired renal function. Twelve-lead electrocardiography revealed sinus rhythm with first-degree atrioventricular block. Chest radiography revealed mediastinal widening. The blood pressures obtained from the 4 limbs showed no significant differences. Subsequently, brain computed tomography revealed no obvious intracranial lesion. A neurologist was consulted, and a recent ischemic stroke could not be ruled out. While in the observation area, his systolic blood pressure decreased to <90 mm Hg and he showed bradycardia, and 12-lead electrocardiography revealed an AV block and long pulse. Contrast-enhanced chest computed tomography revealed no evidence of aortic dissection. Another family member reported a history of lithium intake for bipolar disorder for >30 years. Blood examination revealed a lithium concentration of 2.65 mEq/L. INTERVENTIONS: A nephrologist was consulted, and emergency hemodialysis was indicated. Dopamine was administered for his shock status via a right neck central venous catheter. OUTCOMES: His lithium level gradually declined after the hemodialysis, and blood pressure and consciousness level improved subsequently. The patient was discharged 9 days later in a stable condition. LESSONS: If an emergency physician encounters a patient with altered consciousness and arrhythmia with cardiogenic shock, the patient's drug intake history should be carefully reviewed to rule out cardiovascular problems on the basis of the patient's clinical condition. Wolters Kluwer Health 2018-11-09 /pmc/articles/PMC6250446/ /pubmed/30407335 http://dx.doi.org/10.1097/MD.0000000000013129 Text en Copyright © 2018 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by/4.0 This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0 |
spellingShingle | Research Article Chien, Shun-Ching Liu, Kuan-Ting Wu, Yen-Hung Lithium intoxication presenting as altered consciousness and arrhythmia with cardiogenic shock: A case report |
title | Lithium intoxication presenting as altered consciousness and arrhythmia with cardiogenic shock: A case report |
title_full | Lithium intoxication presenting as altered consciousness and arrhythmia with cardiogenic shock: A case report |
title_fullStr | Lithium intoxication presenting as altered consciousness and arrhythmia with cardiogenic shock: A case report |
title_full_unstemmed | Lithium intoxication presenting as altered consciousness and arrhythmia with cardiogenic shock: A case report |
title_short | Lithium intoxication presenting as altered consciousness and arrhythmia with cardiogenic shock: A case report |
title_sort | lithium intoxication presenting as altered consciousness and arrhythmia with cardiogenic shock: a case report |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6250446/ https://www.ncbi.nlm.nih.gov/pubmed/30407335 http://dx.doi.org/10.1097/MD.0000000000013129 |
work_keys_str_mv | AT chienshunching lithiumintoxicationpresentingasalteredconsciousnessandarrhythmiawithcardiogenicshockacasereport AT liukuanting lithiumintoxicationpresentingasalteredconsciousnessandarrhythmiawithcardiogenicshockacasereport AT wuyenhung lithiumintoxicationpresentingasalteredconsciousnessandarrhythmiawithcardiogenicshockacasereport |