Reactions 1680, p208 - 2 Dec 2017
Lithium toxicity and arrhythmic complications
following suicide attempt: case report
A man in his 60s [age not clearly stated] developed lithium
toxicity, prolonged QTc interval and right bundle-branch block
following lithium [lithium carbonate] overdose in a suicide
The man was hospitalised for significant lithium overdose.
He had a history of recurrent depressive disorder. Prior to
admission, he was taking lithium 800mg once a night along
with other treatment medications. He had recently been
diagnosed with a rare skin carcinoma (on his legs). He
underwent radical surgery for the skin carcinoma. He reported
this surgery to be distressing. A year before admission, he
became socially isolated following a relationship breakdown.
He self-administered 50x400mg lithium along with a pint of
beer with an intention of suicide. Twelve hours later, he
experienced diarrhoea, dizziness, abdominal pain and profuse
vomiting. He reported this overdose to the admitting staff and
paramedics. He was dehydrated at the time of admission. Past
pointing and cerebellar ataxia were noted on neurological
examination. Creatinine level increased from 75 µmol/L to
108 µmol/L and bicarbonate level was at 28.1 mmol/L. The
serum lithium level (after 12 hours of overdose) was 4.7 mEq/L
(normal therapeutic range 0.4-1.0 mEq/L). ECG revealed a
prolonged QTc of 490ms and right bundle-branch block.
The man was started on haemofiltration and received
3 cycles of therapy. His all psychotropic medications were
withheld. Following third haemofiltration, the serum lithium
level reduced to 0.88 mEq/L.
Six days after the overdose, when the man’s serum lithium
level reached 0.67 mEq/L, treatment with lithium was started
again. Twenty four hours after starting lithium, he presented
with dysarthria, bilateral tremor and dystonia. At this point of
time, his serum levels were within normal therapeutic range.
He was transferred to a psychiatric hospital. He again showed
signs of catatonic stupor. Therefore, he was detained and
electroconvulsive therapy was administered.
Author comment: "Here we describe a case of severe
lithium overdose." "Lithium neurotoxicity is a potential
complication of lithium therapy, most typically in patients on
chronic lithium who experience an acute overdose".
De Cates AN, et al. Lithium overdose and delayed severe neurotoxicity: Timing
for renal replacement therapy and restarting of lithium. BMJ Case Reports 2017:
222453, 25 Oct 2017. Available from: URL: http://doi.org/10.1136/
bcr-2017-222453 - United Kingdom
Reactions 2 Dec 2017 No. 16800114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved