Figure 4
We temporarily held abiraterone acetate and bicalutamide use because
they can cause prolonged QT intervals. The answer to the patient’s
initial tests was prepared during this period. The results were as
follows: hemoglobin 14.8 g/dL, glomerular filtration rate
(GFR) 73.2 mL/min/1.73 m2, creatinine (Cr) 1 mg/dL, potassium 3.8
mmol/mL, magnesium 1.7 mg/dL, calcium 9.5 mg/dL, serum
albumin 3.5 g/dL, troponin 19.7 ng/mL, TSH 2 mIU/L (NL:0.5 to 5.0
mIU/L), AST 49 U/L, ALT 52 U/L, ALP 86 IU/L. the blood test showed
that he had low magnesium levels. The low magnesium levels led to the
development of PVC and torsade de pointes. We immediately started him on
intravenous magnesium supplementation (MGSO4, 1 to 2 gr in 10 cc DW5%
over 2 min and 1gr /hour infusion for 24 hr) to raise his magnesium
levels and prevent further cardiac events. We also monitored his heart
rhythm closely with continuous cardiac monitoring. Even though we
treated the patient’s hypomagnesemia, he still had a prolonged QT
interval. The CT scan of the brain and lungs showed the expected
results.