Milk-alkali syndrome

Milk-alkali syndrome is 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.

Pathophysiology
Ingestion of over 2g of elemental calcium per day may lead to this disorder. When a large quantity of calcium is ingested and absorbed by the GI tract, hypercalcemia works to feedback on the parathyroid gland to inhibit production of PTH. This, in turn, leads to an increased absorption of bicarbonate in the kidney, establishing metabolic alkalosis. Additionally, hypercalcemia produces a concentrating defect in the kidney which can be considered a form of nephrogenic diabetes insipidus.

Clinical
Effects due to hypercalcemia may be remembered by bones, stones, groans and psychiatric undertones. This means an increased risk of Kidney stones, bone fractures, anorexia, vomiting, constipation and a host of psychiatric effects, including weakness, fatigue and altered mental status. Thus, a level of serum calcium must be obtained, but a full workup must include total/ionized calcium, albumin, phosphate, PTH, PTHrP, vitamin D and TSH. In addition, evaluation of hypercalcemia must include an ECG, which may show a short QT interval.

REFERENCES

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1. eMedicine.com - Milk-Alkali Syndrome ([1]).