Hypercalcemia secondary to excessive self-medication with antacids causing acute pancreatitis: a case report

Abstract

Excessive self-medication with over-the-counter drugs is an issue commonly encountered by health care professionals. It can result in uncommon presentations of life-threatening illnesses. These medications are frequently overlooked by clinicians when taking histories from patients, and their risks are often downplayed. We present the case of a 35-year-old woman with acute pancreatitis secondary to hypercalcemia. This condition occurred due to long-term excessive self-administration of calcium-rich antacid tablets. Her clinical course involved multifactorial rebound hypocalcemia after treatment and multiple complications from the abuse of other non-prescription medications. Acute pancreatitis secondary to antacid-induced milk-alkali syndrome has been minimally reported in the literature. There are no reports describing rebound hypocalcemia as a complication of its treatment or presenting this pathology in the context of multiple over-the-counter drug abuse. This case highlights the importance of taking thorough drug histories, including non-prescription medications, in acute clinical assessments.

Purtscher-Like Retinopathy in a Patient With Milk-Alkali Syndrome and Pancreatitis

“…9,10 Hypercalcemia-induced pancreatitis may occur as a result of milk-alkali syndrome. 4,5 Proposed mechanisms of hypercalcemia-induced pancreatitis include pancreatic duct deposition of calcium and calcium-induced conversion of trypsinogen to trypsin. 10 In the case we have presented here, the presumptive diagnosis was pancreatitis secondary to severe hypercalcemia associated with milk-alkali syndrome.…”

“…3 The disease became uncommon after the introduction of modern treatments for peptic ulcer disease including histamine blockers and proton pump inhibitors, but more recently has had a resurgence because of the overuse of over-the-counter calcium carbonate for self-treatment of reflux and osteoporosis prevention. [3][4][5] Milk-alkali syndrome is now the third most common cause of in-hospital hypercalcemia. 3,5 In the case we have presented here, the patient developed milk-alkali syndrome due to longterm daily consumption of an antacid containing sodium bicarbonate in combination with calcium supplements for parathyroid dysfunction.…”

“…1 Milk-alkali syndrome, which is characterized by the clinical triad of hypercalcemia, metabolic alkalosis, and renal failure, and is caused by the consumption of large amounts of calcium and alkali, may result in pancreatitis secondary to severe hypercalcemia. [3][4][5] We report the case of a patient who developed Purtscher-like retinopathy in the setting milk-alkali syndrome and pancreatitis.…”

Over-the-Counter Drug Causing Acute Pancreatitis

“…Hypercalcemia associated with primary hyperparathyroidism contributes to 3.6% cases of pancreatitis cases, while pancreatitis induced by excess consumption of over-the-counter (OTC) calcium carbonate is rare and very seldom reported in the literature. 3,4 In this article, we present the case of a young male with pancreatitis secondary to OTC calcium carbonate medications.…”

Untitled

“…Although it is held that antacids are generally safe at recommended doses and usually present with few side effects due to their low systemic absorption 7 , their continuous abuse have been associated with some reported adverse effects. For example, there has been a report of acute pancreatitis secondary to hypocalcaemia from the abuse of calcium-containing antacids 8 . Additionally, when large doses of antacids are taken for long periods of time, significant adverse effects may occur especially in patients with underlying conditions such as chronic renal failure 7,9 .…”