Just a quick question concerning hypercalcemia and A-Fib!

Dinith88 · Apr 17, 2004

Hmmmm. I cant recall ever taking care of a pt whose AF was induced by hypercalcemia....but i know that it CAN cause rhythm problems (don't know exactly which ones..atrial, ventricular, or both??).

How high was it and why? (significant hypercalcemia is rarely seen in isolation..) I would look into other causes before pegging this on the pt's calcium.

What is the cardiologist saying?

MarkHammerschmidt · Apr 17, 2004

My experience is that arrhythmias are usually caused by something that's causing a given chamber to stretch. In patients with chronically high pulmonary pressures, like smokers, the right side of the heart has a hard time perfusing the stiff lungs, and starts to stretch, get hypertrophic, too big. "Cor pulmonale" - aka "lungers'-heart". Stretched. If you stretch the primary pacemaking tissues in the RA in this way, you get a-fib - the smoker's arrhythmia. That fit the patient at all? Liver disease will do the same thing, chronically elevating the right-sided pressures...

nursepenny · Apr 17, 2004

Thanks for the replies, guys.

The pt is an 83 y/o w/f. I am unsure what the calcium level was on admission. She was a direct admit from Dr.'s office so we didn't have a copy of the labs. I understood she had been to her PMD and labs were abnormal and he called family and had her admitted. Cardioligist has not seen pt this AM.

Pt said she had never smoked, but then she could have been around smokers all her life.

I didn't have a history and physical on the chart this AM, but will be checking it tonight when I get to work.

I do know Cancer can cause elevated Ca++ levels. Hmmmm. Very interesting.

We have had several pts. lately with high Ca++ levels. Maybe it is in the water....

Again , thanks for the response. Will keep you informed.

jnette, ASN, EMT-I · Apr 17, 2004

Thanks for the replies, guys.
The pt is an 83 y/o w/f. I am unsure what the calcium level was on admission. She was a direct admit from Dr.'s office so we didn't have a copy of the labs. I understood she had been to her PMD and labs were abnormal and he called family and had her admitted. Cardioligist has not seen pt this AM.
Pt said she had never smoked, but then she could have been around smokers all her life.
I didn't have a history and physical on the chart this AM, but will be checking it tonight when I get to work.
I do know Cancer can cause elevated Ca++ levels. Hmmmm. Very interesting.
We have had several pts. lately with high Ca++ levels. Maybe it is in the water....
Again , thanks for the response. Will keep you informed.

Any renal studies done on your patient? Has she been drinking a lot of the "supplemental beverages" (Ensure, etc.)

Havin' A Party!, ASN, RN · Apr 17, 2004

Have also heard that excess Ca can trigger AF (excitatory effect). Seems everyone's on a Ca kick these days -- even folks that don't need to supplement it. Promotions for Ca are all over the place.

Also believe Ca is antagonistic to K.

Has her intercellular Mg been checked?

Has it been determined that she didn't AF prior to this recent episode?

So many things to check before an accurate diagnosis can be made... diet (including MSG, artificial sweeteners, supplements, etc.), use of liquor, valvular probs, etc.

nursepenny · Apr 18, 2004

To the best of my knowledge, pt.'s renal status in WNL. In fact this mornings lab draw only her CO2 was elevated @31. Everything else on Basic (BMP) {think this was chem 7 at one time} was normal. Even Ca++.

I am not sure if Mg has been checked, but would assume so.

I did find out this a chronic condition for pt. Ca++ elevates, pt comes in for NS boluses and Calcitonin injections and then is sent home. As of this morning still no treatment for A-Fib. Told day shift to mention it to Dr. this AM. Geez nurses have to do it all...