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Milk-Alkali Syndrome

Tyler R. Reese, MD and Ahmad H. Yassin, DO, MA, FS Reviewed 06/2018
 


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 for in...

DIAGNOSIS

HISTORY

  • Calcium-containing supplement use

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

    • Nausea, vomiting, constipation

    • Polyuria

    • Mental status changes including lethargy, irritabi...

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

PATIENT EDUCATION

Daily calcium should not exceed 1.2 to 1.5 g. 

PROGNOSIS

REFERENCES

1
Suki WN, Yium JJ, Von Minden M, et al. Acute treatment of hypercalcemia with furosemide. N Engl J Med.  1970;283(16):836–840. [View Abstract on OvidMedline]
2
Arroyo M, Fenves AZ, Emmet...

ADDITIONAL READING

  • Malcolm OT. Identification, treatment, and prevention of calcium-alkali syndrome in elderly patients. Consult Pharm.  2015;30(8):444–454.

  • Patel AM, Goldfarb S. Got calcium? Welc...

CODES

ICD10

E83.52 Hypercalcemia 

ICD9

275.42 Hypercalcemia 

SNOMED

43258006 Milk alkali syndrome (disorder) 

CLINICAL PEARLS

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

  • Daily calcium supplementation should not exceed 1.2 to 1.5 g.

  • Treatment is based on stopping excess consumpt...

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