SAT247 CODE STEMI Due To Excessive Ingestion Of TUMS

Abstract

Abstract Disclosure: E. Hershkop: None. Hypercalcemia is defined as a serum calcium greater than 10.5mg/dL. It is most commonly caused by malignancy or hyperparathyroidism; a less common cause is excess calcium ingestion, referred to as Milk Alkali Syndrome (MAS). Severe hypercalcemia can lead to renal failure, arrhythmias, and coma. A rare EKG finding is ST elevation mimicking an acute ST Elevation Myocardial Infarction (STEMI). We describe a case of severe hypercalcemia caused by excessive ingestion of TUMS antacids that presented as diffuse ST elevations on EKG which were mistaken for an acute MI. To our knowledge, this is the first case in the literature describing hypercalcemia with ST elevations caused by excessive TUMS ingestion. Case: A 74 year old male with a history of diabetes, hypertension, stroke, and acid reflux presented for recurrent falls due to leg weakness. He endorsed constipation with bowel movements every 5-6 days. Upon further questioning, he reported taking 6 to 7 TUMS antacid tablets (each containing 200mg calcium) daily for the past two months to treat ‘heartburn’. He denied having chest pain. His medications included hydrochlorothiazide, losartan, amlodipine, atorvastatin, glimepiride, and famotidine. On physical exam he had reduced strength in both lower extremities - 1/5 left, 3/5 right. EKG on arrival showed ST elevation in leads III, aVF, and V1-V5, with T wave inversions in aVR and aVL, suggestive of a STEMI. A STEMI code was called. Since he denied chest pain, troponins were lateralized at 0.1 ng/mL, and an echocardiogram showed no wall motion abnormalities, cardiology recommended conservative management. Laboratory evaluation revealed calcium of 15.5 mg/dL, albumin of 3.8 g/dL, BUN of 39 mg/dL, creatinine of 2.2 mg/dL, magnesium of 1.4 mg/dL, phosphorus of 3 mg/dL, 25-OH vitamin D of 24 ng/mL, PTH of 9 pg/mL, undetectable 1-25 OH vitamin D and PTHrP, and normal TSH and SPEP. CT head/chest/abdomen/pelvis showed no evidence of malignancy. He was treated with IV hydration and 1 dose of calcitonin. His calcium level, leg strength, and ST elevations began to improve within 12 hours and returned to normal within four days. Conclusion: Our patient had severe hypercalcemia likely secondary to excessive consumption of oral antacid tablets, as other causes were ruled out, and his EKG findings masqueraded as a STEMI-a rare presentation of hypercalcemia. Consumption of supplements may be overlooked when investigating hypercalcemia and should be specifically asked about. In addition, providers should be aware of EKG changes found in hypercalcemia to avoid unnecessary cardiac intervention. Presentation: Saturday, June 17, 2023