Use of Furosemide for Milk-Alkali Syndrome

Homler, Howard

doi:10.4065/84.6.562-b

Cited by 1 publication

(2 citation statements)

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“…The initial treatment for hypercalcemia is saline infusion therapy [ 14 ]. There is no evidence that diuretics exacerbate alkalosis or renal dysfunction, as long as adequate infusions are administered [ 15 ]. Loop diuretics are contraindicated for the treatment of hypercalcemia in cases of volume depletion, as this worsens the hypercalcemic contraction alkalosis.…”

Section: Discussionmentioning

confidence: 99%

“…Her main blood test results are presented in Table 1. The results of her urinalysis were as follows: K, 22.2% (10-20); P, 30.0% (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20); Mg, 4.2% (2-3); urinary K/Cr ratio, 25.4 mEq/g•Cr; and urinary Ca excretion, 0.32 mg/dLGF (Table 1). A 12-lead electrocardiogram (ECG) revealed the following findings: heart rate, 59 beats/min; rhythm, sinus rhythm; T wave, flat-low; and QTc, 0.53 s. Computed tomography (CT) without chest enhancement showed no enlarged lymph nodes in the mediastinum or hilar region.…”

Section: Case Presentationmentioning

confidence: 99%

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A Case of Milk-Alkali Syndrome Caused by Diuretic-Induced Alkalosis and Polypharmacy

2023

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Milk-alkali syndrome, which is characterized by hypercalcemia, metabolic alkalosis, and renal dysfunction, typically results from the ingestion of large amounts of calcium and absorbable alkaline products. However, these symptoms can also manifest when alkalosis and calcium loading occur simultaneously, owing to other factors. We report a case of milk-alkali syndrome caused by loop-diuretic-induced alkaline load and polypharmacy in an 85-year-old Japanese woman with multiple comorbidities, including osteoporosis, hypertension, type 2 diabetes, dyslipidemia, and Parkinson’s disease. The patient regularly took 14 drugs, including calcium L-aspartate, eldecalcitol, celecoxib, and a fixed-dose combination of losartan and hydrochlorothiazide. Immediately before admission, furosemide was administered for the treatment of edema. The patient presented with chest discomfort, general malaise, and clinical signs of dehydration, hypercalcemia, hypophosphatemia, hypokalemia, and hypomagnesemia, accompanied by electrocardiogram abnormalities, renal dysfunction, and chloride-resistant metabolic alkalosis. The hypercalcemia was specifically induced by calcium L-aspartate and eldecalcitol. The hypomagnesaemia and hypophosphatemia were caused by diuretics and hypercalcemia. Thus, all the oral medications were discontinued, and rehydration and electrolyte correction therapy were administered. The final diagnosis was milk-alkali syndrome caused by the concomitant use of loop diuretics and other medications, without absorbable alkaline preparation use. This case underscores the importance of considering drug-related factors, checking concomitant medications, and being aware of the benefits, harmful effects, and side effects of polypharmacy in older adults with multimorbidity.

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Section: Discussionmentioning

confidence: 99%