Calcium-Alkali Syndrome Due to Vitamin D Administration and Magnesium Oxide Administration

Calcium-Alkali Syndrome-Like Symptoms Manifested by Daily Alphacalcidol and Thiazide

“…The triad (hypercalcemia, metabolic alkalosis, and various degrees of kidney injury) can occur whenever alkalosis and a calcium load coexist, not only with concomitant calcium and alkali ingestion (11,12). Several other investigators recommended that the term "calcium-alkali syndrome" should replace "milkalkali syndrome" for early recognition of this disease (10)(11)(12)(13).…”

“…The triad (hypercalcemia, metabolic alkalosis, and various degrees of kidney injury) can occur whenever alkalosis and a calcium load coexist, not only with concomitant calcium and alkali ingestion (11,12). Several other investigators recommended that the term "calcium-alkali syndrome" should replace "milkalkali syndrome" for early recognition of this disease (10)(11)(12)(13). In this case report, we use the term calciumalkali syndrome to include cases of traditional milk-alkali syndrome, highlighting that a range of circumstances associated with a calcium load and alkalosis may cause hypercalcemia (11)(12)(13).…”

Got Calcium? Welcome to the Calcium-Alkali Syndrome

“…7,8 The "milk" in milk-alkali syndrome no longer reflects the etiologic origin of the modern version of this disorder, and some suggest the condition be renamed the calcium-alkali or Rolaids-yogurt syndrome. 9,10 We also recommend changing the name to the calcium-alkali syndrome in deference to a new epidemiology and emerging pathophysiology surrounding renal calcium metabolism. The integral feature of the calcium-alkali syndrome is a history of excessive ingestion of calcium and often absorbable alkali, producing the classic triad of hypercalcemia, metabolic alkalosis, and varying degrees of renal insufficiency.…”

“…20 Patients with anorexia nervosa occasionally have food fetishes rich in calcium, 10,21 and cardiac transplant patients are sometimes given calcium carbonate. 17 Dialysis patients who ingest large amounts of magnesium oxide and calcium carbonate also develop calcium-alkali syndrome, 9 as can betel nut chewers in Asia because betel nuts are often blended with a lime paste made from ground oyster shells containing calcium oxide and calcium hydroxide. 22 Several other medications, including aluminum hydroxide and magnesium hydroxide, provide a source of absorbable alkali in patients with calcium-alkali syndrome who also ingest large doses of calcium.…”

“…Hypercalcemia causes renal vasoconstriction, thereby decreasing GFR and reducing amounts of filtered calcium, self-propagating a vicious cycle. 9,11 Whereas the overall characteristics of renal tubular calcium handling are well described, 11,14 recent studies on the role of the calciumsensing receptors (CaSRs), which are located along the thick ascending loop of Henle and the distal nephron, provide new insights into the mechanism of calcium-alkali syndrome (Figure 1).…”