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Electrocardiac effects associated with lithium toxicity in children: an illustrative case and review of the pathophysiology

Published online by Cambridge University Press:  14 September 2015

Dhiraj Singh ,
Akinbolaji Akingbola ,
Nancy Ross-Ascuitto  and
Robert Ascuitto
Dhiraj Singh
Affiliation:
Department of Pediatrics, Division of Cardiology, Louisiana State University School of Medicine, New Orleans, Louisiana, United States of America Children’s Hospital of New Orleans, Louisiana, United States of America
Akinbolaji Akingbola
Affiliation:
Department of Pediatrics, Division of Cardiology, Louisiana State University School of Medicine, New Orleans, Louisiana, United States of America
Nancy Ross-Ascuitto
Affiliation:
Department of Pediatrics, Division of Cardiology, Louisiana State University School of Medicine, New Orleans, Louisiana, United States of America Children’s Hospital of New Orleans, Louisiana, United States of America
Robert Ascuitto*
Affiliation:
Department of Pediatrics, Division of Cardiology, Louisiana State University School of Medicine, New Orleans, Louisiana, United States of America Children’s Hospital of New Orleans, Louisiana, United States of America
*
Correspondence to: Dr R. Ascuitto PhD, MD, Department of Pediatrics, Division of Cardiology, LSU School of Medicine., 200 Henry Clay Avenue, New Orleans, Louisiana 70118, United States of America. Tel: +504-896-9751; Fax: +504-896-3952; E-mail: nrossascuitto@yahoo.com
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Abstract

Lithium is a potent psychotherapeutic agent that has gained wide acceptance in paediatrics, especially as adjunct treatment for severe behavioural, anxiety, and attention-deficit hyperactivity disorders, along with bipolar conditions. Its cardiac toxicity has been well-documented in adults; however, information is limited regarding lithium’s effects on the heart in children. Therefore, paediatric cardiologists following-up children on lithium therapy should be cognizant of the cardiac side-effects and pathophysiology associated with this drug. In this manuscript, we used an illustrative case of a child who presented with lithium poisoning, in order to highlight adverse clinical manifestations that can arise from this medication. The cardiac cell membrane is thought to be the primary site of lithium’s action. Thus, we reviewed lithium’s effects on membrane electrogenic pumps and channels involved in the distribution and passage of sodium, potassium, and calcium across the sarcolemma, as these ions, and their associated currents, are the primary determinates of the action potentials underlying auto-rhythmicity and contractile activity of the heart.

Keywords

Lithiumtoxicitycardiacelectrocardiogramaction potential
Type
Review Articles
Information
Cardiology in the Young , Volume 26 , Issue 2 , February 2016 , pp. 221 - 229
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Copyright
© Cambridge University Press 2015 

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