case_images: PMC11822235_01
case_images: Electrocardiogram on the first day of admission.. Initial ECG demonstrates sinus rhythm with frequent premature ventricular complexes. The patient was asymptomatic, reporting no palpitations or chest discomfort.
case_images: cureus-0017-00000077402-i01.jpg
case_images: PMC11822235_01_cureus-0017-00000077402-i01.jpg
case_images: FIG1
case_images: The initial ECG showed a heart rate of 76 bpm with sinus rhythm and frequent premature ventricular complexes (Figure 1).
case_images: Electrocardiogram during bradycardia episode.. ECG performed on the 14th day of admission revealed complete atrioventricular (AV) block, a junctional escape rhythm, and T-wave inversion, correlating with the observed bradycardia and an elevated serum lithium level of 2.47 mEq/L.
case_images: cureus-0017-00000077402-i02.jpg
case_images: PMC11822235_01_cureus-0017-00000077402-i02.jpg
case_images: FIG2
case_images: ECG and an assessment for potential electrolyte imbalances or medication interactions contributing to the condition. ECG findings indicated a complete AV block pattern, junctional escape rhythm, and T wave inversion (Figure 2).
case_images: Changes in serum lithium levels and clinical findings during hospitalization.. This figure depicts the changes in serum lithium levels (mEq/L) over the course of hospitalization and key clinical findings. Lithium therapy (300 mg TID) was initiated on Day 1 and discontinued on Day 14 due to elevated serum lithium levels (2.47 mEq/L) and the development of bradycardia with complete atrioventricular (AV) block, as confirmed by ECG. Antihypertensive medications (telmisartan 80 mg QD and amlodipine 5 mg QD), which were part of the patient's long-term blood pressure management regimen, were continued from prior to admission until Day 14. Serum lithium levels decreased following discontinuation of lithium therapy and supportive management, including hydration. By Day 16, Holter ECG revealed sinus rhythm with isolated premature ventricular contractions (PVCs). The green shaded area represents the therapeutic range for serum lithium (0.6-1.2 mEq/L). Clinical findings, including the Glasgow Coma Scale (GCS), heart rate (HR), and blood pressure (BP), are annotated at key time points.
case_images: cureus-0017-00000077402-i03.jpg
case_images: PMC11822235_01_cureus-0017-00000077402-i03.jpg
case_images: FIG3
case_images: The patient's heart rate gradually improved to 55-75 bpm and returned to sinus rhythm as serum lithium levels steadily declined, measuring 1.30 mEq/L, 0.97 mEq/L, and 0.51 mEq/L on consecutive days (Figure 3). The patient was discharged on day 22 with a stable mood and no residual complications from lithium intoxication (Figure 3).