Excessive calcium ingestion leading to milk-alkali syndrome

Bailey, C S; Weiner, Juliane; Gibby, O M; Penney, M D

doi:10.1258/acb.2008.008006

Cited by 9 publications

(6 citation statements)

References 9 publications

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“…Calcium-containing antacids may be considered a primary causative factor in the development of MAS [37]. Pregnant women who use calcium-containing antacids in the form of .3 g elemental calcium/d resulting in MAS have been reported recently [33,35,38]. We found no evidence of adverse events in a review of medical charts, although one third of participants exceeded the UL for calcium.…”

Section: Discussionmentioning

confidence: 52%

Vitamin/Mineral Supplements and Calcium-Based Antacids Increase Maternal Calcium Intake

Mannion¹,

Lindop

2009

Journal of the American College of Nutrition

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Section: Discussionmentioning

confidence: 52%

Vitamin/Mineral Supplements and Calcium-Based Antacids Increase Maternal Calcium Intake

Mannion¹,

Lindop

2009

Journal of the American College of Nutrition

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“…The risks associated with calcium preparations are often assumed by patients as being minimal, with many patients likely taking high daily doses under the maxim that “more is better” [12,13]. Chronic health conditions and the use of medications such as thiazide diuretics, angiotensin converting enzyme inhibitors, angiotensin receptor blockers, and non-steroidal anti-inflammatory drugs (NSAIDs) have also been implicated [6].…”

Section: Discussionmentioning

confidence: 99%

Hypercalcemia Associated with Calcium Supplement Use: Prevalence and Characteristics in Hospitalized Patients

Machado

Bruce-Mensah

Whitmire

et al. 2015

JCM

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Background: The ingestion of large amounts of milk and antacids to treat peptic ulcer disease was a common cause of hypercalcemia in the past (the “milk-alkali syndrome”). The current popularity of calcium and supplements has given rise to a similar problem. Objectives: To evaluate the prevalence and characteristics of hypercalcemia induced by calcium intake (“calcium supplement syndrome”; or CSS) in hospitalized patients. Methods: We conducted a retrospective; electronic health record (EHR)-based review of patients with hypercalcemia over a 3-year period. Diagnosis of CSS was based on the presence of hypercalcemia; a normal parathyroid hormone (PTH) level; renal insufficiency; metabolic alkalosis; a history of calcium intake; and documented improvement with treatment. Results: Of the 72 patients with non-PTH mediated hypercalcemia; 15 (20.8%) satisfied all the criteria for the diagnosis of CSS. Calcium; vitamin D; and multivitamin ingestion were significantly associated with the diagnosis (p values < 0.0001; 0.014; and 0.045 respectively); while the presence of hypertension; diabetes; and renal insufficiency showed a trend towards statistical significance. All patients received intravenous fluids; and six (40%) received calcium-lowering drugs. The calcium level at discharge was normal 12 (80%) of patients. The mean serum creatinine and bicarbonate levels decreased from 2.4 and 35 mg/dL on admission respectively; to 1.6 mg/dL and 25.6 mg/dL at discharge respectively. Conclusion: The widespread use of calcium and vitamin D supplementation can manifest as hypercalcemia and worsening of kidney function in susceptible individuals. Awareness among health care professionals can lead to proper patient education regarding these health risks.

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“…22 In the case described by Bailey where a multiparous patient presented with seizures, treatment with bisphosphonates was initiated after delivery. 22 Our patient's renal dysfunction was complicated by the presence of a concurrent urinary tract infection. Treatment with ceftriaxone was avoided because the calcium-containing solution is known to cause a fatal precipitation reaction in neonates.…”

Section: Discussionmentioning

confidence: 99%

“…Creatinine was 1.9 mg/dl (normal 0.75-1.50), urea nitrogen 23 mg/dl (normal , and bicarbonate 30 mEq/l (normal [22][23][24][25][26][27][28]. Based on a urinalysis that showed a specific gravity of 1.010, pH 5.5, and significant white blood cells and leukocyte esterase, she received ampicillin and ceftriaxone.…”

Section: Case Reportmentioning

confidence: 99%

Hypercalcemia in Pregnancy: A Case of Milk-Alkali Syndrome

et al. 2011

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Milk-alkali syndrome is a rare cause of hypercalcemia characterized by the triad of hypercalcemia, renal insufficiency, and metabolic alkalosis that results from the overconsumption of calcium containing products. In the setting of pregnancy where there is a physiologic increase in calcium absorption, milkalkali syndrome can be potentially life threatening. We report a case of a 26-year-old woman in her second trimester of pregnancy who presented with 2 weeks of flank pain, nausea, vomiting, anorexia, headache, and lightheadedness. The history revealed consumption of a large quantity of milk, calcium carbonate antacid, and calcium-containing prenatal vitamins. Her symptoms and hypercalcemia resolved with intravenous fluids and a loop diuretic. With the increased use of calcium carbonate for peptic ulcer disease, gastroesophageal reflux disease, and osteoporosis, milk-alkali syndrome has experienced a resurgence and must be considered in the differential diagnosis of hypercalcemia. In this clinical vignette we review the literature on milk-alkali syndrome in pregnancy and discuss important diagnostic and therapeutic considerations when managing the pregnant patient with hypercalcemia.KEY WORDS: hypercalcemia; milk-alkali syndrome; pregnancy. J Gen Intern Med 26(8):

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Excessive calcium ingestion leading to milk-alkali syndrome

Cited by 9 publications

References 9 publications

Vitamin/Mineral Supplements and Calcium-Based Antacids Increase Maternal Calcium Intake

Vitamin/Mineral Supplements and Calcium-Based Antacids Increase Maternal Calcium Intake

Hypercalcemia Associated with Calcium Supplement Use: Prevalence and Characteristics in Hospitalized Patients

Hypercalcemia in Pregnancy: A Case of Milk-Alkali Syndrome

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