Sinus node dysfunction in a patient with lithium intoxication.
Lithium can suppress sinus node function, especially when it is used concomitantly with carbamazepine. We describe a 42-year-old woman who took lithium and carbamazepine for manic-depressive psychosis and seizure disorders, and developed marked sinus node dysfunction. Drug screening showed a toxic serum lithium level of 3.38 mmol/L and a normal serum carbamazepine level of 22.1 mumol/L. An electrophysiologic study showed prolongation of the corrected sinus node recovery time (CSNRT) of up to 9,708 msec. After three sessions of hemodialysis, normal sinus rhythm was resumed. The serum lithium level was 0.1 mmol/L 2 weeks later, and the CSNRT shortened to 309 msec. Because the combination of lithium and carbamazepine in psychiatric patients is not uncommon, recognition of the potential complication of severe bradyarrhythmia is essential in the emergency care of such patients.
Lai
C L
CL
Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Chen
W J
WJ
Huang
C H
CH
Lin
F Y
FY
Lee
Y T
YT
D000328:Adult; D002220:Carbamazepine / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008094:Lithium / Q000506:poisoning*; D012849:Sinoatrial Node / Q000187:drug effects* / Q000502:physiology
D002220:Carbamazepine; D008094:Lithium