Rare ECG finding in a patient with severe hypercalcaemia

Published Date: 21st June 2021

Publication Authors: Chaplin G, Malik A, Katira R

A man in his late 60s with a significant history of decompensated alcohol-related liver disease was admitted to hospital with a 2-week history of increasing jaundice and pruritus as well as confusion, drowsiness and a decreased exercise tolerance. Routine bloods revealed an exceptionally elevated corrected calcium level which peaked at 5.17 mmol/L. On admission, Alpha-fetoprotein (AFP) was also greatly increased (126 278 U/L). These two derangements were later discovered to be due to an underlying diagnosis of hepatocellular carcinoma on CT. Due to his severe hypercalcaemia, the patient was admitted to the coronary care unit for cardiac monitoring and treatment. This patient was treated with immediate fluid resuscitation, intravenous pamidronate and calcitonin in order to reduce his calcium levels. A 12-lead ECG was performed (figure 1) which showed Osborn waves (figure 2). This resolved after therapy (figure 3). Although an MRI liver was arranged for a more detailed assessment, unfortunately he deteriorated significantly and became encephalopathic. Despite optimal treatment, the patient died, receiving supportive input from the palliative care team.

Chaplin, G; Malik, A; Katira, R. (2021). Rare ECG finding in a patient with severe hypercalcaemia. BMJ Case Reports. 14 (6), e242000

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