{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T05:00:33Z","timestamp":1790830833704,"version":"4.1.0"},"reference-count":8,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Gastroenterol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Lithium toxicity can rarely manifest as cardiac arrhythmias, often initially presenting as bradycardia. Bowel obstruction is a rare cause of acute lithium toxicity. We present a case of lithium-induced symptomatic bradycardia induced by cecal volvulus.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case report<\/jats:title>\n                    <jats:p>An 84-year-old female with a history of bipolar 1 disorder on chronic lithium therapy was admitted for symptomatic bradycardia and abdominal pain. She also presented with myoclonus, polydipsia, and encephalopathy. Laboratory evaluation revealed lithium toxicity in the setting of renal impairment, and abdominal imaging findings indicated large bowel obstruction secondary to cecal volvulus. Lithium was discontinued, and the patient was managed supportively. Despite declining lithium levels, the patient\u2019s symptomatic bradycardia persisted until surgical correction of the volvulus, after which cardiac and neurological function markedly improved.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance<\/jats:title>\n                    <jats:p>This case highlights the potential role of gastrointestinal obstruction in exacerbating lithium-induced bradycardia by impairing its clearance and inducing a vagal response triggered by abdominal distension.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fgstr.2026.1728396","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T04:32:49Z","timestamp":1790829169000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Lithium-induced bradycardia triggered by cecal volvulus: a case of obstruction-associated drug accumulation"],"prefix":"10.3389","volume":"5","author":[{"given":"Akram","family":"Alnounou","sequence":"first","affiliation":[{"name":"Western Michigan University Homer Stryker MD School of Medicine","place":["Kalamazoo, MI, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry","family":"Zou","sequence":"additional","affiliation":[{"name":"Western Michigan University Homer Stryker MD School of Medicine","place":["Kalamazoo, MI, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madison","family":"Laird","sequence":"additional","affiliation":[{"name":"Western Michigan University Homer Stryker MD School of Medicine","place":["Kalamazoo, MI, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Visak","sequence":"additional","affiliation":[{"name":"Western Michigan University Homer Stryker MD School of Medicine","place":["Kalamazoo, MI, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sage","family":"Bilsland","sequence":"additional","affiliation":[{"name":"Western Michigan University Homer Stryker MD School of Medicine","place":["Kalamazoo, MI, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie","family":"Numbers","sequence":"additional","affiliation":[{"name":"Western Michigan University Homer Stryker MD School of Medicine","place":["Kalamazoo, MI, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil","family":"Hughes","sequence":"additional","affiliation":[{"name":"Western Michigan University Homer Stryker MD School of Medicine","place":["Kalamazoo, MI, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,1]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1002\/clc.22822","article-title":"Lithium\u2010induced electrocardiographic changes: a complete review","volume":"40","author":"Mehta","year":"2017","journal-title":"Clin Cardiol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.21427","article-title":"Arrhythmia with lithium toxicity requiring urgent dialysis: a case report","volume":"14","author":"Rijal","year":"2022","journal-title":"Cureus"},{"key":"B3","doi-asserted-by":"publisher","first-page":"502","DOI":"10.1016\/j.jemermed.2008.02.064","article-title":"Adynamic ileus in chronic lithium intoxication","volume":"38","author":"Perale","year":"2010","journal-title":"J Emerg Med"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-116-9-739","article-title":"Lithium toxicity associated with a trichobezoar","volume":"116","author":"Thornley-Brown","year":"1992","journal-title":"Ann Intern Med"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1093\/omcr\/omae107","article-title":"A case of acute lithium poisoning and hypermagnesemia involving advanced colon cancer-induced colonic obstruction","volume":"2024","author":"Takayama","year":"2024","journal-title":"Oxf Med Case Rep"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(11)61516-X","article-title":"Lithium toxicity profile: a systematic review and meta-analysis","volume":"379","author":"McKnight","year":"2012","journal-title":"Lancet"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1097\/MJT.0000000000001374","article-title":"Lithium-induced gastroparesis in a newly diagnosed bipolar disorder patient","author":"Philip","year":"2021","journal-title":"Am J Ther"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1525.e5","DOI":"10.1016\/j.ajem.2018.05.002","article-title":"Gastrocardiac syndrome: a forgotten entity","volume":"36","author":"Saeed","year":"2018","journal-title":"Am J Emerg Med"}],"container-title":["Frontiers in Gastroenterology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fgstr.2026.1728396\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T04:32:58Z","timestamp":1790829178000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fgstr.2026.1728396\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,1]]},"references-count":8,"alternative-id":["10.3389\/fgstr.2026.1728396"],"URL":"https:\/\/doi.org\/10.3389\/fgstr.2026.1728396","relation":{},"ISSN":["2813-1169"],"issn-type":[{"value":"2813-1169","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,1]]},"article-number":"1728396"}}