Milk-alkali syndrome with a serum calcium level of 22 mg/dl and J waves on the ECG.
A man with severe hypercalcemia (22 mg/dl) secondary to ingestion of a calcium carbonate antacid (Tums) was admitted with obtundation and hyperreflexia, which disappeared with treatment. Laboratory values, which were consistent with milk-alkali syndrome, included low-normal serum chloride (96 mEq/L), normal phosphorus of 2.7 mg/dl (phosphorus is usually normal to increased in this syndrome), increased blood urea nitrogen (39 mg/dl), and increased serum creatinine (2.4 mg/dl). A normal C-terminal parathormone level helped distinguish this patient from patients with severe hypercalcemia due to primary hyperthyroidism. The ECG revealed a widened rather than a shortened QT interval, as well as a J wave, a broadened T wave, and a U wave with this marked hypercalcemia, all of which reverted to normal with correction of the hypercalcemia.
Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock.
J K
JK
Jenkins
T R
TR
Best
S A
SA
Nicks
F Y
FY
Murphy
K L
KL
Bussell
D L
DL
Vesely
D000368:Aged; D000863:Antacids / Q000009:adverse effects; D002118:Calcium / Q000097:blood*; D002119:Calcium Carbonate / Q000009:adverse effects; D004562:Electrocardiography; D006321:Heart / Q000503:physiopathology; D006801:Humans; D006934:Hypercalcemia / Q000097:blood* / Q000139:chemically induced / Q000503:physiopathology; D008297:Male; D012651:Self Medication
D000863:Antacids; D002119:Calcium Carbonate; D002118:Calcium