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Milk-Alkali Syndrome

Tyler R. Reese, MD, FAAFP and Ahmad H. Yassin, DO, MA, FS Reviewed 06/2019
 


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 ind...

DIAGNOSIS

HISTORY

  • Calcium-containing supplement use

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

    • Nausea, vomiting, constipation

    • Polyuria

    • Mental status changes including lethargy, irrita...

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: ...

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 g. 

PROGNOSIS

Favo...

REFERENCES

1
Medarov BI. Milk-alkali syndrome. Mayo Clin Proc.  2009;84(3):261–267. [View Abstract on OvidMedline]
2
Arroyo M, Fenves AZ, Emmett M. The calcium-alkali syndrome. Proc (Bayl Univ Med C...

ADDITIONAL READING

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

  • Patel AM...

CODES

ICD10

E83.52 Hypercalcemia 

ICD9

275.42 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 consumption and ens...

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