title: Lithium overdose with electrocardiogram changes suggesting ischemia.
abstract: BACKGROUND
  Lithium toxicity is associated with electrocardiogram (ECG) changes, but changes suggestive of an ST segment elevation myocardial infarction have not been reported.
  
  
  METHODS
  A 46-year-old incarcerated man suffering from diabetes, hypertension, and schizoaffective/bipolar disorder was treated with lithium 1,200 mg twice daily. Two days prior to presentation the patient became confused, ataxic, and anorexic in jail. Lithium level was 4.69 mmol/L. He was transferred to the emergency department. On arrival, vital signs were normal. The ECG showed a normal sinus rhythm. ST segments were elevated in the anterior leads with downward concavity. T waves were biphasic. Since these changes suggested cardiac ischemia and the patient was unable to respond to questions about chest pain, cardiac enzymes and an emergent echocardiogram were done. Troponin I was less than 0.1 microg/L. Echocardiogram was normal, without wall motion abnormalities. Treatment was with hemodialysis and whole-bowel irrigation. Postdialysis lithium level was 1.30 mmol/L. Over the next several days, electrocardiogram normalized. His speech gradually became coherent. After a 1-week hospitalization, he returned to jail.
  
  
  CONCLUSIONS
  Lithium intoxication can cause transient ST segment elevations suggesting an acute myocardial infarction. In the absence of a clear history, echocardiogram and cardiac enzymes can be used to rule out a myocardial infarction.
authors.affiliation: Department of Emergency Medicine, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Puhr
authors.forename: Jason
authors.initials: J
authors.lastname: Hack
authors.forename: Jacquelyn
authors.initials: J
authors.lastname: Early
authors.forename: William
authors.initials: W
authors.lastname: Price
authors.forename: William
authors.initials: W
authors.lastname: Meggs
mesh_terms: D018692:Antimanic Agents / Q000506:poisoning* / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000150:complications / Q000188:drug therapy; D062787:Drug Overdose; D004562:Electrocardiography / Q000187:drug effects*; D006801:Humans; D008094:Lithium / Q000097:blood; D018020:Lithium Compounds / Q000506:poisoning* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000139:chemically induced / Q000503:physiopathology; D017202:Myocardial Ischemia / Q000139:chemically induced* / Q000503:physiopathology*; D011329:Prisoners; D011618:Psychotic Disorders / Q000150:complications / Q000188:drug therapy
chemical_list: D018692:Antimanic Agents; D018020:Lithium Compounds; D008094:Lithium