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Milk-Alkali Syndrome

Beshoy Sidhom, MD Reviewed 06/2021
 


BASICS

DESCRIPTION

  • Milk-alkali syndrome results from ingestion of excessive amounts of calcium and absorbable alkali (e.g., bicarbonate and citrate salts)

  • Historically seen during self-treatment of indi...

DIAGNOSIS

HISTORY

  • Calcium-containing supplement use

  • Symptoms of hypercalcemia (“stones, bones, moans, groans and behavioral health overtones”):

    • Nausea, vomiting, constipation, abdominal pain

    • Polyuria

    • Menta...

TREATMENT

GENERAL MEASURES

  • Stop calcium and alkali (carbonate salts):

    • Supplements

    • Over-the-counter antacids

  • Volume expansion

    • To maintain urine output of 3 L/day

MEDICATION

First Line

  • Treat hypercalcemia:

    • Hydra...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

  • Kidney function

  • Fluid intake and output

  • Correction of calcium after treatment

DIET

  • Increase oral fluid intake.

  • Stop calcium and vitamin D supplementa...

REFERENCES

1
Medarov  BI. Milk-alkali syndrome. Mayo Clin Proc.  2009;84(3):261–267. [View Abstract on OvidMedline]
2
Arroyo  M, Fe...

ADDITIONAL READING

  • Goltzman D. Nonparathyroid Hypercalcemia. Front Horm Res. 2019;51:77-90.

  • Malcolm  OT. Identification, treatment, and prevent...

CODES

ICD10

E83.52 Hypercalcemia 

SNOMED

43258006 Milk alkali syndrome (disorder) 

CLINICAL PEARLS

  • Aggressive over-the-counter antacid or calcium supplement use can lead to hypercalcemia.

  • Calcium supplementation should not exceed 1.2 g/day.

  • Treat by stopping excess antacid/supplement ...

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