Prolongation of the Q-T interval in lithium toxicity

doi:10.1016/S0022-0736(79)80054-0

Journal of Electrocardiology

Volume 12, Issue 1, 1979, Pages 117-119

https://doi.org/10.1016/S0022-0736(79)80054-0 Get rights and content

Summary

A patient with lithium intoxication and Q-T prolongation is described. As serum lithium levels fell with therapy, serial electrocardiograms (ECGs) demonstrated T wave changes more commonly associated with lithium. All changes were ultimately reversible.

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Cited by (16)

Lithium concentration correlates with QTc in patients with psychosis
2005, Journal of Electrocardiology
QT prolongation induced by antipsychotics has been reported to be a determinant for the development of torsade de pointes and sudden death. However, the effect of lithium on QT interval has not been fully clarified. The aim of the present study was to elucidate the relationship between serum lithium concentration and QT interval in patients treated with lithium. We examined serum lithium concentrations and electrocardiographic features in 39 inpatients with bipolar affective disorder or schizophrenia. The longest QT interval in the 12 electrocardiographic leads was measured using GE Marquette QT guard System Software, and Bazett formula was used for heart rate correction. The longest QTc was positively correlated with lithium concentration (r = 0.46, P = .003). Multiple regression analysis revealed that sex (female, P = .037), lower serum K⁺ concentration (P = .029), and especially, higher serum lithium concentration (P = .009) were determinants for the prolongation of the QTc.
Lithium intoxication: Manifestations and management
1987, American Journal of Emergency Medicine
The clinical diagnosis of lithium intoxication can be elusive because of the slow onset and diversity of toxic manifestations. Mental status and neurologic symptoms often predominate. After the diagnosis is made, management depends on the clinical presentation and serum lithium level. Hemodialysis is the treatment of choice for severe lithium intoxication. Two cases of lithium intoxication are presented that demonstrate that predisposing factors and drug interactions play major roles. A review is given of the pathophysiology, presenting signs, symptoms, and approaches to treatment of lithium intoxication.
Lithium toxicity with rarely reported ECG manifestations
1982, Annals of Emergency Medicine
A case of severe lithium intoxication treated successfully with hemodialysis is presented. In addition to the common neurological manifestations of toxicity, the patient demonstrated three rarely reported cardiotoxic manifestations; reversible first degree A–V block, intraventricular conduction delay, and prolonged Q–T interval. These findings demonstrate the need to include lithium intoxication in the differential diagnosis of drug overdose with prominent ECG changes. The pharmacology, presenting signs and symptoms, and current treatment modalities of lithium intoxication are reviewed.
QT interval measurement by a computer assisted program: A potentially useful clinical parameter
1982, Journal of Electrocardiology
The duration of electrical systole (QT interval) was measured in 72 subjects (48 women and 24 men) who had normal coronary arteries and left ventricular function at cardiac catheterization (group 1). The same measurements were obtained in 100 patients with a normal ECG (from 40 women and 60 men referred to our institution and found normal on a noninvasive clinical basis) and compared to a double independent manual calculation (group 2). The computer assisted program was found reliable in QT interval measurements. In both study groups women showed longer QTc. No difference in QTc duration was seen in subjects taking β-blockers prior to angiography. As compared to group 1, subjects of group 2 showed similar average QTc values. However, 9 out of 100 subjects of group 2 had abnormal QTc as compared with none of group 1 (p<0.05). QTc calculations may improve the usefulness of computer assisted programs in ECG interpretation. Present data can be used as reference values for normality. They stress in addition the necessity of introducing the heart rate correction for the interpretation of QT interval. This can help in stimulating prospective clinical studies to assess the value of QTc as an index of risk for cardiac dysrhythmias.
Electrocardiographic Changes during Initiation of Lithium Augmentation of Antidepressant Pharmacotherapy
2022, Journal of Clinical Psychopharmacology
Lithium-induced electrocardiographic changes: A complete review
2017, Clinical Cardiology

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¹: From the Section of Cardiology, Veterans Administration Hospital, and the University of Miami School of Medicine, Miami, Florida.

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Prolongation of the Q-T interval in lithium toxicity*

Summary

J Electrocardiol

Am J Med

The cardiovascular effects of lithium in man

Am J Med

Lithium salts: 1970–1975

Annals of Int Med

Mechanisms of lithium action

N Eng J Med

Drugs and the treatment of psychiatric disorders