Hypercalcemia, metabolic alkalosis and renal failure secondary to calcium bicarbonate intake for osteoporosis prevention - 'modern' milk alkali syndrome: a case report

Abstract

We report a case of a patient presenting with a triad of hypercalcemia, metabolic alkalosis and renal failure secondary to calcium bicarbonate intake for osteoporosis prevention. It is the classical presentation of the “modern” milk alkali syndrome that presents several characteristics distinguishing it from the “old” syndrome described secondary to peptic ulcer disease treatment. Milk alkali syndrome affects middle-aged female patients taking over-the-counter calcium carbonate. Clinically, these patients present in an acute hypercalcemia crisis, responding rapidly to hydration. The phosphorus level is normal to low. Bisphosphonate should be used cautiously due to the risk of symptomatic hypocalcemia.

Milk alkali syndrome in an infant with chronic kidney disease

“…Abnormalities in serum calcium concentration may have profound effects on the neurological and gastrointestinal systems as well as on renal function. 11 It is also associated with metastatic calcifications, pancreatitis, and reversible cardiac conduction abnormalities.…”

“…10 Clinically, these patients present in an acute hypercalcemic crisis, responding rapidly to hydration with no need for bisphosphonates because the phosphorus level is usually normal to low. 11 The chronic form of milk alkali syndrome is usually asymptomatic, with the incidental finding of hypercalcemia and renal failure.…”

Calcium-Alkali Syndrome in the Modern Era

“…Initially, the traditional milk-alkali syndrome was characterized by elevated serum phosphate concentration, probably secondary to the ingestion of phosphate-rich milk and cream in the Sippy diet [21]. In contrast, calcium-alkali syndrome is associated with hypophosphatemia or low-normal serum phosphorus level as a result of the phosphate-binding capacity of calcium carbonate and other calcium containing supplements resulting in decreased phosphate absorption.…”

Síndrome calcio-alcalinos: actualización de un antiguo problema clínico

“…La existencia de una enfermedad renal subyacente no es un prerrequisito, pero sí un factor que contribuye a su desarrollo [30][31][32][33] . Ademá s de la elevació n de la calcemia, en el SCA «moderno» es característico que las concentraciones sé ricas de fó sforo se encuentren dentro de los límites normales o incluso por debajo de é stos, porque la ingesta de leche no es en la actualidad un factor precipitante, y por el efecto quelante del carbonato cá lcico 7,12,28,34,35 .…”