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Diagnosis and Treatment > Signs and Symptoms

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  • Appetite reduction/loss x
  • Renal failure x
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Bidhya Timilsina Department of Internal Medicine, Diabetes and Metabolism, Department of Medicine, Reading Hospital, Reading, Pennsylvania, USA

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Niranjan Tachamo Department of Internal Medicine, Diabetes and Metabolism, Department of Medicine, Reading Hospital, Reading, Pennsylvania, USA

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Prem Raj Parajuli Department of Internal Medicine, Diabetes and Metabolism, Department of Medicine, Reading Hospital, Reading, Pennsylvania, USA

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Ilan Gabriely Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, Reading Hospital, Reading, Pennsylvania, USA

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Summary

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-alkali syndrome (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 and prevent unnecessary tests and treatments.

Learning points:

  • Suspect milk-alkali syndrome in patients with hypercalcemia, metabolic alkalosis and renal failure, especially in context of ingestion of excess calcium-containing supplements.

  • Careful history of over-the-counter medications, supplements and diet is crucial to diagnose milk-alkali syndrome.

  • Milk-alkali syndrome may cause severe hypercalcemia in up to 25–30% of cases.

Taxonomy:
Clinical Overview, Gland/Organ, Kidney, Parathyroid, Topic, Bone, Hormone, PTH, TSH, Condition/ Syndrome, Hypercalcaemia, Patient Demographics, Age, Geriatric, Gender, Female, Ethnicity, White, Country of Treatment, United States, Diagnosis and Treatment, Signs and Symptoms, Abdominal pain, Appetite reduction/loss, Confusion, Constipation, Depression, Fatigue, Hypercalcaemia, Pyrosis, Renal failure, Investigation, 25-hydroxyvitamin-D3, Albumin, Bicarbonate, Calcium (serum), Creatinine, Estimated glomerular filtration rate, Kidney function, Magnesium, pH (blood), Phosphate (serum), PTH, TSH, Vitamin D, Intervention, Fluid repletion, Medication, Antibiotics, Calcium carbonate, Saline, Vitamin D, Related Disciplines, General practice, Geriatrics, Neurology, Publication Details, Case Report Type, Error in diagnosis/pitfalls and caveats
DOI:
https://doi.org/10.1530/EDM-18-0075
Volume/Issue:
Volume 2018: Issue 1
Open access