리튬 독성으로 인한 완전 방실 전도장애

Complete Heart Block due to Lithium Toxicity

  리튬 독성으로 인해 완전 방실 전도장애가 발생한 증례를 보고한다. 환자는 53세 여성이며 정동분열장애 진단하에 일일 리튬 1500㎎을 복용하였는데 체중조절을 위해 식이 제한을 한 이후 전신 허약감과 근육 무력증을 나타내다가 갑작스런 의식저하를 나타내어 응급실을 방문하였다. 당시 리튬의 혈중 농도는 5.22 mEq/L였으며 실시한 심전도 검사에서 완전 방실 전도장애가 관찰되어 일시형 인공 심박동기를 삽입하였고 리튬의 혈중 농도가 감소하면서 자발적인 심박동이 돌아왔다. 리튬의 심장 독성을 예방하기 위해 철저한 병력조사와 규칙적인 심전도 촬영 등이 필요하다. 리튬 치료 시 급격한 식이 조절이나 탈수상태는 심각한 결과를 가져올 수 있으며 리튬의 독성 증상과 가능성에 대한 환자와 보호자의 교육이 중요하다.

&nbsp;&nbsp;Lithium treatment has been associated with a wide range of cardiac complications. We observed a 53-year-old female patient who presented with complete heart block due to lithium toxicity. The patient had been diagnosed as schizoaffective disorder and had been taking a stable dose of lithium, 1,500 ㎎/day since January 2007. Recently, she begun a strict diet and experienced muscle weakness and lethargy a few days later. While receiving fluid therapy, she lost her consciousness and was transferred to an emergency medical center. An electrocardiogram revealed that she had complete heart block, so a temporary pacemaker was inserted immediately. After 4 days of&nbsp;&nbsp;intensive care, her heartbeat recovered spontaneously and the temporary pacemaker was removed. On the 11<SUP>th</SUP> day, she had sufficiently recovered and could ambulate by herself. Lithium levels were measured at 5.22 mEq/L and 0.66 mEq/L on the 1<SUB>st</SUB> and 4<SUB>th</SUB> day of treatment, respectively. This case illustrates the importance of educating patients and their relatives about the possible lithium toxicity caused by a strict diet.