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Milk-Alkali Syndrome

Matthew A Rushing, M. Ed., M.D. Reviewed 05/2023
 


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 in...

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

  • Discontinue thiazide diuretics in favor of a different drug class (e.g., loop diuretics)

  • Volume ...

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 supplementat...

REFERENCES

1
Patel AM, Adeseun GA, Goldfarb S. Calcium-alkali syndrome in the modern era. Nutrients. 2013;5(12):4880–93. doi: 10.3390/nu5124880. PMID: 24288027 PMCID: PMC3875933.
2
...

ADDITIONAL READING

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

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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