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General Rehabilitation

Oral Calcium Supplementation with Prolonged QTc Interval Prior to Initiating QTc Prolonging Medications: A Case Report.

Friday, October 24, 2025
8:00 AM - 9:15 AM MT
Location: Kiosk 1
Disclosure(s):
Benjamin Sims, MD: No financial relationships to disclose
Meghan Oram, DO: No financial relationships to disclose
Joshua J. Startup, MD: No financial relationships to disclose
Case Diagnosis: A patient who suffered a stroke was given calcium supplementation to correct a prolonged QTc interval prior to starting donepezil for aphasia.

Case Description or Program Description: A 70-year-old male was admitted to inpatient rehabilitation (IPR) after they experienced an acute ischemic stroke with bilateral multifocal infarcts. Imaging revealed lesions in the bilateral centrum semiovale, left frontoparietal cortex, left temporal cortex, left putamen, and left cerebellum. His initial deficits included incomplete right hemiplegia, aphasia, dysarthria, impaired balance/gait, and cognitive/personality changes. Routine EKG obtained on admission to inpatient rehabilitation revealed a prolonged QTc interval of 464.

During the IPR course, consideration was given to a trial of donepezil for the treatment of aphasia. Given the known adverse cardiac side effects of donepezil, prolonged QTc interval, initiation was deferred in the setting of the patient’s already prolonged QTc interval.

To decrease QTc interval prior to starting donepezil the patient was started on oral calcium supplementation with calcium carbonate 1250 mg BID.

Setting: Inpatient Rehabilitation Hospital

Assessment/Results: After the 6th dose of calcium carbonate a repeat EKG revealed a QTc of 412, improved from 462 on admission, a level at which the team felt safe initiating donepezil. The patient was not started on the medication due to improvement in aphasia symptoms during the treatment course with calcium. The patient’s corrected calcium levels changed from 8.9 to 9.1 after the 6 doses.

Discussion (relevance): This is the first case, to our knowledge, of calcium supplementation with the goal of improving QTc to a level safe for the use of QTc prolonging medications in the post stroke inpatient rehabilitation setting.

Conclusions: For inpatient rehabilitation patients with a prolonged QTc, calcium supplementation may provide an avenue for safe administration of QTc prolonging medications.