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.