Acute milk-alkalisyndrome A 74-year-old woman presented with progressive lethargy, confusion, poor appetite and abdominal pain. She was found to have non-PTH-mediated severe hypercalcemia with renal failure and metabolic alkalosis. Extensive workup for hypercalcemia to rule out alternate etiology was unrevealing. Upon further questioning, she was taking excess calcium carbonate (Tums) for her worsening heartburn. She was diagnosed with milk-alkalisyndrome (MAS). Her hypercalcemia and alkalosis recovered completely with aggressive hydration along with improvement in her renal function. High index of suspicion should be maintained and history of drug and supplements, especially calcium ingestion, should be routinely asked in patients presenting with hypercalcemia to timely diagnose MAS
Pulmonary and gastric metastatic calcification due to milk-alkalisyndrome: a case report The incidence of metastatic calcification is influenced by high serum calcium and phosphate concentrations and local physicochemical conditions, such as pH. A high pH accelerates tissue calcification. Patients with milk-alkalisyndrome typically present with renal failure, hypercalcemia, and metabolic alkalosis, which are caused by the ingestion of calcium and absorbable alkali. Among patients with impairment of renal function, milk-alkalisyndrome is a major cause of hypercalcemia. Long-term use of furosemide will lead to hypokalemia, metabolic alkalosis, and eventually renal failure (i.e., pseudo-Bartter syndrome). Even if the level of calcium ingestion is relatively low, the renal failure caused
Antacids, Altered Mental Status, and Milk-AlkaliSyndrome The frequency of milk-alkalisyndrome decreased rapidly after the development of histamine-2 antagonists and proton pump inhibitors for the treatment of peptic ulcer disease; however, the availability and overconsumption of antacids and calcium supplements can still place patients at risk (D. P. Beall et al., 2006). Here we describe
or months, thought to be due to stimulation of bone resorption and inhibition of bone formation [Borgan, 2022]. * Calcium * Excessive calcium supplement use or excess calcium intake may lead to hypercalcaemia [BMJ Best Practice, 2022]. * Milk-alkalisyndrome is defined by hypercalcaemia, metabolic alkalosis and acute kidney injury, and is caused by ingestion of large amounts of calcium and absorbable
]. * Milk-alkalisyndrome was historically associated with antacid treatment, but is becoming more common due to increased prescribing and over-the-counter use of calcium and vitamin D preparations in the management of osteoporosis, and has become the third most common cause of hypercalcaemia [Motlaghzadeh, 2021; Rout, 2024]. * Hypercalcaemia occurs in: * 6-18% of people with sarcoidosis [Sève, 2021
of the bladder 5. Vescial orfice Degree of patient pain * This factor usually determines whether a patient can tolerate outpatient treatment options, pain control and remain hydrated.[2] Name 6 risk factors for urolithiasisSee box 89-2 * Metabolic disease or disturbance * Crohn’s disease * Milk-alkalisyndrome * Primary hyperparathyroidism * Hypernatriuria * Hyperuricosuria * Sarcoidosis