Effects of Toxic Lithium Levels on ECG-Findings from the LiSIE Retrospective Cohort Study

(1) Background: Few studies have explored the impact of lithium intoxication on the heart. (2) Methods: We examined electrocardiogram (ECG) changes associated with lithium intoxication in the framework of the LiSIE (Lithium-Study into Effects and Side Effects) retrospective cohort study. We analysed...

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Bibliographic Details
Published in:Journal of clinical medicine 2022-10, Vol.11 (19), p.5941
Main Authors: Truedson, Petra, Ott, Michael, Lindmark, Krister, Ström, Malin, Maripuu, Martin, Lundqvist, Robert, Werneke, Ursula
Format: Article
Language:English
Subjects:
Angina pectoris
Cardiac arrhythmia
Cardiology
Clinical medicine
Cohort analysis
Consent
drug-related side effects and adverse reactions
Electrocardiography
Ethics
Heart
Hyperkalemia
Hypokalemia
Hypotheses
Intensive care
Intoxication
kardiologi
Laboratories
Lithium
long QT syndrome
medicin
Medicine
Pacemakers
Patients
Potassium
Psychiatry
psykiatri
Risk factors
toxicity
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Summary:(1) Background: Few studies have explored the impact of lithium intoxication on the heart. (2) Methods: We examined electrocardiogram (ECG) changes associated with lithium intoxication in the framework of the LiSIE (Lithium-Study into Effects and Side Effects) retrospective cohort study. We analysed ECGs before, during, and after intoxication. (3) Results: Of the 1136 patients included, 92 patients had experienced 112 episodes of lithium intoxication. For 55 episodes, there was an ECG available at the time; for 48 episodes, there was a reference ECG available before and/or after the lithium intoxication. Lithium intoxication led to a statistically significant decrease in heart rate from a mean 76 beats/min (SD 16.6) before intoxication to 73 beats/min (SD 17.1) during intoxication ( = 0.046). QTc correlated only weakly with lithium concentration (ρ = 0.329, = 0.014). However, in 24% of lithium intoxication episodes, there were QT prolongations. In 54% of these, QTc exceeded 500 ms; patients with chronic intoxications being more affected. (4) Conclusions: Based on summary statistics, effects of lithium intoxication on HR and QTc seem mostly discrete and not clinically relevant. However, QT prolongation can carry a risk of becoming severe. Therefore, an ECG should always be taken in patients presenting with lithium intoxication.
ISSN:2077-0383
2077-0383
DOI:10.3390/jcm11195941