title: Milk-alkali syndrome associated with calcium carbonate consumption. Report of 7 patients with parathyroid hormone levels and an estimate of prevalence among patients hospitalized with hypercalcemia.
abstract: Milk-alkali syndrome can be caused by ingesting large amounts of calcium carbonate. Coincident with the promotion of calcium carbonate as treatment for both dyspepsia and osteoporosis, milk-alkali syndrome is now a common cause of hypercalcemia severe enough to require admission to the hospital. The syndrome accounted for less than 2% of such admissions before 1990, but from 1990 through 1993, it was the cause of hypercalcemia for over 12% of these patients. Only primary hyperparathyroidism and hypercalcemia of malignancy (excluding multiple myeloma) are more common. The diagnosis of milk-alkali syndrome is made almost entirely based on the patient's history; careful attention to dietary practices and over-the-counter drug use is required, as numerous over-the-counter medications contain calcium carbonate. Modern assays for PTH demonstrate the expected suppression of PTH by hypercalcemia. Nonetheless, measurement of PTH must be performed in a timely manner as treatment with intravenous saline may result in hypocalcemia and elevated PTH soon after admission. Given the pathophysiology of milk-alkali syndrome compared to other causes of hypercalcemia, hypocalcemia with rebound hyperparathyroidism is probably unique to milk-alkali syndrome.
authors.affiliation: Department of Medicine, University of Oklahoma Health Science Center, Oklahoma City.
authors.forename: D P
authors.initials: DP
authors.lastname: Beall
authors.forename: R H
authors.initials: RH
authors.lastname: Scofield
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002119:Calcium Carbonate / Q000009:adverse effects*; D005260:Female; D006760:Hospitalization; D006801:Humans; D006934:Hypercalcemia / Q000097:blood / Q000139:chemically induced* / Q000503:physiopathology; D015592:Immunoradiometric Assay; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D012189:Retrospective Studies
chemical_list: D010281:Parathyroid Hormone; D002119:Calcium Carbonate