The Milk-Alkali Syndrome Caused by Betelnuts in Oyster Shell Paste

Wu, Kwan‐Dun; Chuang, Rong-Bin; Wu, Felin-lin Lin; Hsu, Wei-An; Jan, I-Shiow; Tsai, Keh–Sung

doi:10.3109/15563659609013839

Cited by 27 publications

(11 citation statements)

References 10 publications

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“…9 For example, in Asia and Africa, the milk-alkali syndrome has been associated with the ancient practice of chewing "betel quid," which is a nut of the Areca catechu "betel palm" treated with a calcium hydroxide lime paste and chewed for its psychogenic effects by approximately 200 million people worldwide. 10,11 Massive cheese ingestion can result in the "cheese alkalosis syndrome" described in a Swedish report of an anorexic/bulimic patient with a pica syndrome for cheese who required multiple hospitalizations. 12 Another account describes an anorexic-bulimic patient who developed a "Rolaids-yogurt syndrome" after chronic daily consumption of 1,700 mg of calcium-containing Rolaids tablets and yogurt.…”

Section: Discussionmentioning

confidence: 97%

Health-Behavior Induced Disease: Return of the Milk-Alkali Syndrome

et al. 2007

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The milk-alkali syndrome is a well-documented consequence of excessive calcium and alkali intake first recognized in association with early 20th century antacid regimens. The syndrome became rare after widespread implementation of modern peptic ulcer disease therapies. With recent trends in osteoporosis therapy coupled with widely available calcium-containing supplements, the milk-alkali syndrome has reemerged as an important clinical entity. Our case illustrates a patient who self-medicated his peptic ulcer disease with a regimen resembling a common early 20th century dyspepsia regimen. When superimposed upon chronic high calcium supplementation, the patient became acutely ill from the milk-alkali syndrome. When taken to excess, or used inappropriately, medications and supplements ordinarily considered beneficial, can have harmful effects. Our case underscores the importance of obtaining a thorough medication history including use of over-the-counter supplementation.

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Section: Discussionmentioning

confidence: 97%

Health-Behavior Induced Disease: Return of the Milk-Alkali Syndrome

et al. 2007

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“…MAS is now the third leading cause of hospitalizations for hypercalcemia, with the incidence being found to be as high as 36% in certain institutions (9). Additionally, the demographics have also changed from affecting middle-aged men with peptic ulcer disease to postmenopausal and pregnant women (10)(11)(12)(13). Betel nut chewing is one of the several causes of MAS.…”

Section: Discussionmentioning

confidence: 99%

“…Betel nut chewing is one of the several causes of MAS. There have been several cases in Asia, first reported in 1996 in Taiwan by Wu (12).…”

Section: Discussionmentioning

confidence: 99%

Betel Nut Chewing: An Unrecognized Cause of Milk Alkali Syndrome

Sendos¹,

Mian

Shah³

2016

AACE Clinical Case Reports

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Objective: To describe an uncommon case of milk alkali syndrome from betel nut chewing. A 60-year-old Pakistani woman was referred to the Endocrinology Clinic for hypercalcemia. She reported a history of type 2 diabetes mellitus, hypothyroidism, anxiety, and renal stones. She denied symptoms of hypercalcemia. However, her serum calcium levels were noted to be above the upper end of reference range but consistently below 11 mg/dL. She was noted to have alkalosis and low parathyroid hormone levels, despite a normal renal function. A 24-hour urine stone profile revealed high-normal urine calcium and low urine citrate levels. Upon further history, it was noted that she avidly chewed betel nut up to 15 times a day, along with lime paste and tobacco paste. She was physically and psychologically addicted to this process. She was also taking calcium supplementations. On exam, she was noted to have dark pigmentation of her tongue from chronic use of lime paste and retention of betel nut in her mouth. Methods: A MEDLINE search was performed with the keyword 'milk-alkali syndrome' using the PubMed search engine. All relevant English-language articles were reviewed. Results: Milk alkali syndrome was highly suspected to be the cause of her hypercalcemia. Patient was encouraged to decrease the frequency of betel nut chewing and discontinue the calcium supplements, along with fluid hydration. Conclusion: Her calcium levels eventually decreased to the reference range after 3 months of discontinuation of her calcium supplements. She is also trying to decrease the frequency of betel nut chewing. (AACE Clinical Case Rep. 2016;2:e172-e175)

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“…[3] Arecoline is hydrolysed quantitatively to arecaidine by the addition of slaked lime. [8] Assuming an amount of 5 g areca nut per quid and a consumption of about 20 quids per day, [36][37][38] a luminal concentration in the lowest millimolar range is conceivable.…”

Section: Physiological Relevance and Transepithelial Transportmentioning

confidence: 99%