Document wgJ5oLxyrQ7YeobemmLbYbEpJ

the material is either infrequent or infrequently re- SUMMARY ported within the United States This case illustrates the serious consequences that may result although the Progressive diffuse pulmonary fibrosis as a sequel to massive aspiration of baby powder talc is docu- ^' patient has recovered from the acute episode and has beenasymptomatic for several years One of the most bizarre cases of talc pneumoconiosis mented The diagnosis should be considered in idiopathic pulmonary fibrosis in childhood and adult life was reported by Nam and Gracey in 1972. Although death was from an unrelated disease the patient had developed extensive talcosis as a result of liberal use of cosmetic talcum powder over a period of 20 years The authors stated that they had been unable to find in the literature a case of pulmonary talcosis associated with the use of cosmetic dusting powder References 1 Cless D. Anger R Erstickungstod Durch Aspiration von Kinderpuder Kinderarzt Prax 22 506 5018934 2 3 mpiration Molnar JJ Nathenson G. Edberg 5 Fatal powder by a child N EnglJ Med 36-37 1962 mpiration of talcum Jenkins MQ Dusting powder inhalation J SC Aled Assoc 59:62 1963 Hughes W. Kalmer T Massive tale aspiration successful treatment with dexamethasone AmJ Dis Child 653-654 1966 Nam A. Gracey DR Pulmonary talcosis from cometic talcum powder JANA. 492-493 1972 Cardiac Arrhythmia and Hypopotassemia in Association With Lithium Carbonate Overdose MOHAMMAD A. HABIBZADEH MD and NICKOLAS H. ZELLER MD Phoenix Ariz FOR OVER 100 years lithium salts have been used in the treatment of various disorders including rheumatism gout hyperthyroidism diabetes mellitus and as a salt substitute in patients with congestive heart failure These uses however proved unrewarding and were associated with significant toxic effects Therapeutic efficacy of lithium salts in the treatnient of depressive psychosis recently has been appreciated Lithium has a narrow therapeutic range and multiple side effects may develop when the serum concentration reaches or exceeds upper therapeutic levels 2.0 to 2.5 mEq Toxic serum levels of lithium can prove fatal Therapeutic serum lithium levels do not appear to have significant cardiotoxic effects but at toxic levels serious cardiac disorders and arrhythmias may develop which require particular attention CASE REPORT ee A year man with no history of cardiovascular disease was taking 300 mg of lithium carbonate b.i.d for the ment of a psychiatric disorder Four hours before admission he took 120 tablets 36 gm of this preparation On arrival at the hospital was in no acute distress The skin and mucous membranes were well hydrated temperature was normal lungs were clear and blood pressure was 125/80 mm Hg The heart rate was min with regular sinus rhythm There were no cardiac abnormalities on palpation or auscultation Except for lateral gaze nystagmus there were no abnormal neurologic findings The serum BUN hemoglobin and hematocrit values were normal Chest roentgenogram was negative The serum lithiwm level was 3 liter one hour after admission three hours after admission it had fallen to 22 liter Other pertinem laboratory and clinical data are outlined in the Table Hospital Course On admission to the hospital gastric lavage was instituted This was followed by oral administration of 60 mil of Fleet Phospho sodium biphosphate and sodium phosphate and activated charcoal Intravenous infusion of 125 mg of aminophylline in 500 mil of normal saline at a rate of 100 mhour From the Cardiovascular Section Veterans Administration 7th St and Indian School Rd Phoenix Arie 850112 Reprint requests to Dr. Hahibzadeh at the above address Pluspiral was begun and continued for 3 hours Twelve hours after admission the serum lithium concentration dropped to 0.66 mErfliter and the potassium to 2.4 mEyliterThis was associated with sinus bradycardia at a rate of 44 to min and periods of ventricular escape filioventricular rhythm at a rate of min without significant clinical symptonis Fig 1. A The idioventricuJar rhythm had a left bundle branch b ock pattern This pattern lasted a few hours and terminated following intravenous in fusion of potassium chlorite solution The sinus bradycardia persisted for over 38 hours in spite of a return of the serum potassium to 4.7 liter and a lithium level of 0.3 mEq Fig 1 B On the fourth day the patient's heart rate was 10 minute A month later while the patient was taking 150 mg of imipra mine hydrochloride Tofranil per clay noninvasive cardiac evaluation was performed The systolic time intervals revealed a prolonged ejection LVET = 103/257 = value of 97/269 = 0,361 phasesleft ventricular ejection time 0.401 as compared with a predicial There were no abnormalities on his vector apex phono- and echocariliograns DISCUSSION The development of sinus bradycardia and idioventricular rhythm in the presence of marked hypo- kalemia in this case was rather unusual This occurred when the lithium level was at a low therapeutic range of 0.66 mEq The patient did not receive diuretics during the course of treatment and the drop in the serum potassium from 4.3 liter to 2.4 liter within 12 hours could not be explained by gastric lavage and intravenous fluid infusion alone Hypokalemia due to gastric lavage and loss of hydrochloric acid is associated with hypochloremic alkalosis This patient had a serum pH of 7.46 and the serum chloride levels were normal Table The development of hypokalemia may have been in part due to the toxic effects of lithium on the kidney and excessive potassium excretion. Low serum potassium causes increased automaticity especially of the latent pacemaker fibers This is probably due to decreased potassium conductance with consequent decreased efflux of potassium in the face of sodium influx Low serum potassium by causing increased excitability tends to lead to 628 May 1977 SOUTHERN MEDICAL JOURNAL Vol 70. No. 5 0006496 JNJ 000285846