title: Severe Hypercalcemia in a Postpartum Patient.
abstract: BACKGROUND
  There are multiple clinical manifestations of hypercalcemia and several causes of hypercalcemia. Hypercalcemia caused by milk-alkali syndrome is increasing in frequency.
  
  
  METHODS
  A 26-year-old woman presented after having undergone caesarian section. She complained of severe myalgias, arthralgias, an inability to ambulate, nausea, vomiting, abdominal pain, and marked depression. Each of these symptoms has a broad differential diagnosis, but when considered together the theme "stones, bones, moans, and groans," seen in patients with hypercalcemia, is evident. This patient was found to have hypercalcemia caused by milk-alkali syndrome related to the ingestion of calcium carbonate. Her symptoms and hypercalcemia resolved with treatment. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians should be aware of the many different symptoms of hypercalcemia. This case emphasizes the need for a careful medication history for any patient presenting with hypercalcemia, including over the counter medications. Physicians should have a high level of suspicion for milk-alkali syndrome in patients with hypercalcemia because milk-alkali syndrome is no longer a rare etiology but rather one of the most common causes of hypercalcemia.
authors.affiliation: Department of Emergency Medicine, McLaren Macomb Medical Center, Mount Clemens, Michigan.
authors.forename: Megan L
authors.initials: ML
authors.lastname: Murphy
authors.affiliation: Department of Emergency Medicine, McLaren Macomb Medical Center, Mount Clemens, Michigan.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mattingly
authors.affiliation: Department of Emergency Medicine, McLaren Macomb Medical Center, Mount Clemens, Michigan.
authors.forename: Craig T
authors.initials: CT
authors.lastname: Meisner
mesh_terms: D000328:Adult; D000863:Antacids / Q000009:adverse effects*; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D002116:Calcitonin / Q000627:therapeutic use; D002119:Calcium Carbonate / Q000009:adverse effects*; D003863:Depression / Q000209:etiology; D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000139:chemically induced* / Q000150:complications / Q000175:diagnosis*; D009120:Muscle Cramp / Q000209:etiology; D018908:Muscle Weakness / Q000209:etiology; D009325:Nausea / Q000209:etiology; D049590:Postpartum Period; D011644:Puerperal Disorders / Q000139:chemically induced* / Q000175:diagnosis*; D014839:Vomiting / Q000209:etiology
chemical_list: D000863:Antacids; D050071:Bone Density Conservation Agents; D002116:Calcitonin; D002119:Calcium Carbonate
keywords: hypercalcemia; milk-alkali syndrome; postpartum; pregnancy