Milk-alkali syndrome in pregnancy.
BACKGROUND
Severe hypercalcemia, a potentially life-threatening medical emergency, is rare in pregnancy.


METHODS
We report a 32-year-old woman presenting early in the second trimester with severe hypercalcemia (total calcium 22 mg/dL), alkalosis, and acute renal insufficiency resulting from excessive ingestion of calcium carbonate-containing antacid for gastroesophageal reflux. The patient was treated with aggressive hydration and furosemide, and received 1 dose of intravenous etidronate, leading to short-term symptomatic hypocalcemia. To our knowledge, this is the third reported case of milk-alkali syndrome in pregnancy.


CONCLUSIONS
Milk-alkali syndrome is an uncommon cause of hypercalcemia in pregnancy. Intravenous hydration with saline should be the cornerstone of treatment, reserving bisphosphonates for selected cases.
Picolos
Michalis K
MK
Department of Internal Medicine, Division of Endocrinology, Diabetes, and Metabolism, The University of Texas Medical School at Houston, Houston, Texas, USA. Michalis.K.Picolos@uth.tmc.edu
Sims
Charles R
CR
Mastrobattista
Joan M
JM
Carroll
Mary A
MA
Lavis
Victor R
VR
D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000628:therapy; D000328:Adult; D000471:Alkalosis / Q000175:diagnosis* / Q000628:therapy; D001774:Blood Chemical Analysis; D003131:Combined Modality Therapy; D004164:Diphosphonates / Q000627:therapeutic use; D005260:Female; D005440:Fluid Therapy / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D006934:Hypercalcemia / Q000175:diagnosis* / Q000628:therapy; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000628:therapy; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D035583:Rare Diseases; D018570:Risk Assessment; D013577:Syndrome
D004164:Diphosphonates