Milk-alkali syndrome overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: {SHA}}
Overview
Milk-alkali syndrome, also called Burnett's syndrome in honour of the American physician who first described it, is characterized by hypercalcemia caused by repeated ingestion of calcium and absorbable alkali (such as calcium carbonate, or milk and sodium bicarbonate). If untreated, milk-alkali syndrome may lead to metastatic calcification and renal failure.
It was most common in the early 20th century, but there has been a recent increase in the number of cases reported.[1][2]
Overview
Historical Perspective
Pathopysiology
Causes
Differentiating Analgesic nephropathy from other Diseases
Risk Factors
Screening
Natural History, Complications and Prognosis
Epidemiology and Demographics
Diagnosis
Diagnostic Study of Choice
Diagnostic Study of Choice
Milk-alkali syndrome is diagnosed by history of excessive calcium consumption, hypercalcemia, metabolic alkalosis and variable degrees of renal insufficiency. [3]
History and Symptoms
Symptoms of milk-alkali syndrome may inculde: dizziness, vertigo, confusion, apathy, nausea, vomiting, anorexia, distaste for milk, headache, anorexia, pruritus, polydipsia, polyuria, muscle aches, tremor, psychosis, and abnormal calcifications (keratopathy, renal calcinosis).[4][5]
Physical Examination
The following should be considered in the physical examination of milk-alkali syndrome: vertigo, confusion, apathy, nausea, vomiting, anorexia, pruritus, polydipsia, polyuria, muscle aches, tremor, psychosis, and abnormal calcifications (keratopathy, renal calcinosis).[4][5][3]
Laboratory Findings
The following laboratory findings are usually seen in milk-alkali syndrome: hypercalcemia, metabolic alkalosis, variable degrees of renal insufficiency, low or normal phosphorus, low Vitamin D, and low PTH.[2][3][6][7]
Electrocardiogram
X-ray
X-ray is not useful in the diagnosis of milk-alkali syndrome. However, X-ray may be useful in excluding other causes of hypercalcemia. Renal calcium deposits are not seen on X-ray in milk-alkali syndrome.[3]
Echocardiography and Ultrasound
Echocardiography is not useful in diagnosis of milk-alkali syndrome. Ultrasound is not useful in the diagnosis of milk-alkali syndrome. However, ultrasound may be helpful in excluding other causes of hypercalcemia.
CT Scan
CT scan is not useful in the diagnosis of milk-alkali syndrome. However, CT scan may be helpful in excluding other causes of hypercalcemia.
MRI
MRI is not useful in the diagnosis of milk-alkali syndrome. However, MRI may be helpful in excluding other causes of hypercalcemia.
Other Imaging Findings
There are no other imaging findings associated with milk-alkali syndrome.
Other Diagnostic studies
There are no other diagnostic studies associated with milk-alkali syndrome.
Treatment
Medical therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
There is insufficient evidence about the cost-effectiveness of therapy in milk-alkali syndrome.
Future or Investigational Therapies
No further or investigational therapies have been suggested in milk-alkali syndrome.
References
- ↑ Caruso JB, Patel RM, Julka K, Parish DC (2007). "Health-behavior induced disease: return of the milk-alkali syndrome". J Gen Intern Med. 22 (7): 1053–5. doi:10.1007/s11606-007-0226-0. PMID 17483976. Unknown parameter
|month=ignored (help) - ↑ 2.0 2.1 Beall DP, Henslee HB, Webb HR, Scofield RH (2006). "Milk-alkali syndrome: a historical review and description of the modern version of the syndrome". Am. J. Med. Sci. 331 (5): 233–42. PMID 16702792. Unknown parameter
|month=ignored (help) - ↑ 3.0 3.1 3.2 3.3 Medarov BI (2009). "Milk-alkali syndrome". Mayo Clin Proc. 84 (3): 261–7. doi:10.1016/S0025-6196(11)61144-0. PMC 2664604. PMID 19252114.
- ↑ 4.0 4.1 Orwoll ES (1982). "The milk-alkali syndrome: current concepts". Ann Intern Med. 97 (2): 242–8. doi:10.7326/0003-4819-97-2-242. PMID 7049033.
- ↑ 5.0 5.1 Texter EC, Laureta HC (1966). "The milk-alkali syndrome". Am J Dig Dis. 11 (5): 413–8. doi:10.1007/BF02233637. PMID 5327389.
- ↑ Kapsner P, Langsdorf L, Marcus R, Kraemer FB, Hoffman AR (1986). "Milk-alkali syndrome in patients treated with calcium carbonate after cardiac transplantation". Arch Intern Med. 146 (10): 1965–8. PMID 3532984.
- ↑ Arroyo M, Fenves AZ, Emmett M (2013). "The calcium-alkali syndrome". Proc (Bayl Univ Med Cent). 26 (2): 179–81. doi:10.1080/08998280.2013.11928954. PMC 3603742. PMID 23543983.