Key result
Hemodialysis restores sinus rhythm within 20 minutes in lithium-induced escape-capture bigeminy.
Why the study?
Cardiac manifestations of chronic lithium toxicity are uncommon and are frequently overshadowed by neurological symptoms.
Case Report (n=1)
No
Severe lithium-associated sinus node dysfunction and escape-capture bigeminy can evolve rapidly despite mild neurological symptoms and can be effectively reversed with urgent hemodialysis without waiting for laboratory confirmation.
Answers are grounded in this paper and cite their sources.
Supports considering urgent hemodialysis for severe lithium-induced sinus node dysfunction; leaves open optimal serum thresholds for initiating extracorporeal clearance in cardiotoxicity.
Cardiac manifestations of chronic lithium toxicity are uncommon and often overshadowed by neurological symptoms.[1] A 56-year-old woman on chronic lithium monotherapy for bipolar disorder underwent a recent dose escalation from 600 mg/day to 900 mg/day.Over the next 3 days, she developed mild gait instability and confusion, followed by severe fatigue.Initial electrocardiography (ECG) revealed sinus bradycardia at 40 beats/min [Figure 1A].
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Dsouza et al. (2026) conducted a case report in Chronic lithium toxicity with sinus node dysfunction and escape-capture bigeminy (n=1). Urgent hemodialysis was evaluated on Restoration of sinus rhythm and reduction of serum lithium concentration. Urgent 4-hour hemodialysis reduced serum lithium from 2.2 to 1.1 mmol/L and restored sinus rhythm within 20 minutes in a patient with lithium-induced escape-capture bigeminy.
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