Milk-Alkali Syndrome: A Historical Review and Description of the Modern Version of the Syndrome

Beall, Douglas P.; Henslee, Heidi B.; Webb, Heather R.; Scofield, R. Hal

doi:10.1097/00000441-200605000-00001

Cited by 73 publications

(92 citation statements)

References 82 publications

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“…The syndrome was associated with the ingestion of large quantities of milk and absorbable alkali to treat peptic ulcer disease [178]. Nowadays, this syndrome is called calcium-alkali syndrome (CAS) [179].…”

Section: Alkali Administration (Non-chloride-depletion Metabolic Alkamentioning

confidence: 99%

Drug-induced acid-base disorders

et al. 2014

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The incidence of acid-base disorders (ABDs) is high, especially in hospitalized patients. ABDs are often indicators for severe systemic disorders. In everyday clinical practice, analysis of ABDs must be performed in a standardized manner. Highly sensitive diagnostic tools to distinguish the various ABDs include the anion gap and the serum osmolar gap. Drug-induced ABDs can be classified into five different categories in terms of their pathophysiology: (1) metabolic acidosis caused by acid overload, which may occur through accumulation of acids by endogenous (e.g., lactic acidosis by biguanides, propofol-related syndrome) or exogenous (e.g., glycol-dependant drugs, such as diazepam or salicylates) mechanisms or by decreased renal acid excretion (e.g., distal renal tubular acidosis by amphotericin B, nonsteroidal antiinflammatory drugs, vitamin D); (2) base loss: proximal renal tubular acidosis by drugs (e.g., ifosfamide, aminoglycosides, carbonic anhydrase inhibitors, antiretrovirals, oxaliplatin or cisplatin) in the context of Fanconi syndrome; (3) alkalosis resulting from acid and/or chloride loss by renal (e.g., diuretics, penicillins, aminoglycosides) or extrarenal (e.g., laxative drugs) mechanisms; (4) exogenous bicarbonate loads: milk-alkali syndrome, overshoot alkalosis after bicarbonate therapy or citrate administration; and (5) respiratory acidosis or alkalosis resulting from drug-induced depression of the respiratory center or neuromuscular impairment (e.g

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Section: Alkali Administration (Non-chloride-depletion Metabolic Alkamentioning

confidence: 99%

Drug-induced acid-base disorders

et al. 2014

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“…Despite the introduction of histamine-2 receptor antagonist and proton pump inhibitors in the treatment of symptoms of peptic ulcer disease, the syndrome is still being reported due to consumption of over-the-counter calcium-containing antacid. 4 The syndrome is now the third most common etiologic factor for hypercalcemia after hyperparathyroidism and malignancy. 4 The syndrome has also been reported among those on calcium carbonate for various conditions including osteoporosis.…”

Section: Discussionmentioning

confidence: 99%

Milk-alkali syndrome in a rare environment associated with an uncommon feature

Amadi

2018

Int J Res Med Sci

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Milk-alkali syndrome is a rare syndrome noted in the premodern era during treatment of peptic ulcer disease with calcium-enriched milk and absorbable alkali. It was associated with hypercalcemia, alkalosis, renal insufficiency and hyperphosphatemia during that era. Its incidence fell following the advent of modern era forms of peptic ulcer treatment. However, the syndrome is re-emerging owing to the availability of over-the-counter calcium carbonate-containing antacids in this modern era but with a low incidence of hyperphosphatemia. The syndrome is rare in our environment and has not been reported. Here, we report a rare case of milk-alkali syndrome associated with hyperphosphatemia in an adult male who presented to us after weeks of ingestion of antacids. He was managed accordingly and made full recovery after four weeks.

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“…5 The incidence of milk-alkali syndrome declined with the arrival of histamine blockers and doxycycline for treatment of peptic ulcer disease; however, the syndrome saw a resurgence beginning in the 1990s in large part as a result of postmenopausal women taking overthe-counter calcium and vitamin D supplements for treatment or prevention of osteoporosis, a chronic disorder affecting more than 10 million individuals in the United States. 5,6 In the modern era, this syndrome is the third most common cause of hospital admission for hypercalcemia after hyperparathyroidism and hypercalcemia of malignancy, with reported incidence ranging from 8 to 38%. 7,8 The "milk" in milk-alkali syndrome no longer reflects the etiologic origin of the modern version of this disorder, and some suggest the condition be renamed the calcium-alkali or Rolaids-yogurt syndrome.…”

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confidence: 99%

“…The integral feature of the calcium-alkali syndrome is a history of excessive ingestion of calcium and often absorbable alkali, producing the classic triad of hypercalcemia, metabolic alkalosis, and varying degrees of renal insufficiency. 5,11,12 The earlier milk-alkali syndrome using the Sippy diet often presented with hyperphosphatemia after prolonged ingestion of phosphorus-containing milk with cream. 13 In contrast, the modern version of calcium-alkali syndrome associates with hypophosphatemia or lownormal serum phosphorus levels as a result of the phosphorus-binding properties of calcium carbonate.…”

mentioning

confidence: 99%

“…13 In contrast, the modern version of calcium-alkali syndrome associates with hypophosphatemia or lownormal serum phosphorus levels as a result of the phosphorus-binding properties of calcium carbonate. 5,11,14 This hypophosphatemia is more pronounced in elderly patients 14 or those with eating disorders, 15 who tend to have relatively low consumption of protein and therefore phosphorus; low phosphate levels stimulate the renal metabolism of calcitriol and, consequently, absorption of calcium by the gut. 16 Levels of 1,25-hydroxyvitamin D in patients with the calcium-alkali syndrome, of course, are generally low in the setting of hypercalcemia, although some are in the lownormal range and perhaps inappropriPublished online ahead of print.…”

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confidence: 99%

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