Milk-alkali syndrome

Background

• Definition: Hypercalcemia due to increased calcium intake in the setting of renal failure
• 3rd most common cause of hypercalcemia, after hyperparathyroidism and malignancy

Clinical Features

• Often due to heavy use of calcium containing antacids
• Headache, confusion, dizziness, poor appetite, psychosis, dry mouth, constipation

Differential Diagnosis

Causes of Hypercalcemia

• Addison's disease
• Calciphylaxis
• Excess vitamin D
• Hypercalcemia of malignancy
• Hyperparathyroidism
• Hyperthyroidism
• Hypothyroidism
• Lithium
• Milk-alkali syndrome
• Paget disease
• Sarcoidosis
• Thiazide diuretics

Evaluation

• High calcium
• Alkalosis
• Normal or high serum phosphate
• Low serum PTH
• Normal serum 25(OH)D
• Normal or low 1,25(OH)D

Management

• Hydration
• Avoidance of calcium / alkali intake

Disposition

• Hospitalization for IV hydration in severe cases

See Also

• Hypercalcemia