title: [A man with a classic serious milk-alkali syndrome and a carcinoma of the stomach].
abstract: A 42-year-old man was transferred to the Emergency Department after his friends had found him unresponsive and confused in his room. He had been experiencing upper abdominal complaints for a period of several months. He had taken large amounts of a calcium carbonate/magnesium subcarbonate preparation (Rennie) and had consumed at least 3 litres of dairy products per day. His behaviour was reported as being more and more abnormal during the previous few weeks. On admission he was confused and agitated and had involuntary movements of his limbs. Laboratory investigation indicated a triple acid base disorder, i.e. metabolic alkalosis, respiratory alkalosis and high anion gap metabolic acidosis, with severe dehydration. The metabolic alkalosis was caused by the intake of large amounts of dairy and antacids: milk-alkali syndrome. The metabolic acidosis was the result of hypovolaemia and pre-renal renal failure and the respiratory alkalosis was caused by hyperventilation due to the organic psychosyndrome. The patient was treated with volume expansion by isotonic saline and the administration of potassium and he was sedated with low-dose midazolam, which led to a full respiratory compensation of the metabolic alkalosis. A few days following admission, both the plasma calcium concentration and renal function returned to normal; the acid-base disorder completely normalized and the organic psychosyndrome disappeared. On gastroduodenoscopy a gastric ulcer was found; biopsies revealed a signet ring cell adenocarcinoma of the stomach.
authors.affiliation: Twenteborg Ziekenhuis, afd. Interne Geneeskunde, Postbus 7600, 7600 SZ Almelo.
authors.forename: F A J
authors.initials: FA
authors.lastname: Verburg
authors.forename: R A A
authors.initials: RA
authors.lastname: van Zanten
authors.forename: R M L
authors.initials: RM
authors.lastname: Brouwer
authors.forename: A J J
authors.initials: AJ
authors.lastname: Woittiez
authors.forename: Th F
authors.initials: TF
authors.lastname: Veneman
mesh_terms: D000138:Acidosis / Q000175:diagnosis*; D000328:Adult; D000471:Alkalosis / Q000175:diagnosis* / Q000209:etiology; D000472:Alkalosis, Respiratory / Q000175:diagnosis / Q000209:etiology; D000818:Animals; D000863:Antacids / Q000009:adverse effects*; D002119:Calcium Carbonate / Q000009:adverse effects; D018279:Carcinoma, Signet Ring Cell / Q000175:diagnosis* / Q000473:pathology; D003611:Dairy Products / Q000009:adverse effects; D003681:Dehydration / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D020896:Hypovolemia / Q000150:complications; D008277:Magnesium Oxide / Q000009:adverse effects; D008297:Male; D008892:Milk / Q000009:adverse effects; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D000863:Antacids; D008277:Magnesium Oxide; D002119:Calcium Carbonate