Hypercalcemia in Pregnancy: A Case of Milk-Alkali Syndrome

Kolnick, Leanne; Harris, Bryan; Choma, David P.; Choma, Neesha N.

doi:10.1007/s11606-011-1658-0

Cited by 22 publications

(14 citation statements)

References 28 publications

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“…In contrast to low calcium intake, excessively high intake will create similar effects as primary hyperparathyroidism in pregnancy: increased net absorption of calcium, maternal hypercalcemia, increased maternal to fetal transfer of calcium, and suppression of the fetal parathyroids (100,483,767). Neonatal hypoparathyroidism has resulted from women consuming 3-6 g elemental calcium daily to treat nausea of pregnancy (100, 767).…”

Section: Human Datamentioning

confidence: 99%

Maternal Mineral and Bone Metabolism During Pregnancy, Lactation, and Post-Weaning Recovery

Kovacs

2016

Physiological Reviews

383

524

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During pregnancy and lactation, female physiology adapts to meet the added nutritional demands of fetuses and neonates. An average full-term fetus contains ϳ30 g calcium, 20 g phosphorus, and 0.8 g magnesium. About 80% of mineral is accreted during the third trimester; calcium transfers at 300-350 mg/day during the final 6 wk. The neonate requires 200 mg calcium daily from milk during the first 6 mo, and 120 mg calcium from milk during the second 6 mo (additional calcium comes from solid foods). Calcium transfers can be more than double and triple these values, respectively, in women who nurse twins and triplets. About 25% of dietary calcium is normally absorbed in healthy adults. Average maternal calcium intakes in American and Canadian women are insufficient to meet the fetal and neonatal calcium requirements if normal efficiency of intestinal calcium absorption is relied upon. However, several adaptations are invoked to meet the fetal and neonatal demands for mineral without requiring increased intakes by the mother. During pregnancy the efficiency of intestinal calcium absorption doubles, whereas during lactation the maternal skeleton is resorbed to provide calcium for milk. This review addresses our current knowledge regarding maternal adaptations in mineral and skeletal homeostasis that occur during pregnancy, lactation, and post-weaning recovery. Also considered are the impacts that these adaptations have on biochemical and hormonal parameters of mineral homeostasis, the consequences for long-term skeletal health, and the presentation and management of disorders of mineral and bone metabolism.

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Section: Human Datamentioning

confidence: 99%

Maternal Mineral and Bone Metabolism During Pregnancy, Lactation, and Post-Weaning Recovery

Kovacs

2016

Physiological Reviews

383

524

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“…Antacids such as aluminum/ magnesium/simethicone formulations (Mylanta) or calcium carbonate (TUMS) can decrease the discomfort and are considered safe in pregnancy as long as women do not exceed the recommended doses and do not take 5 Rey et al, 6 Ali and Egan L, 7 Malfertheiner et al, 8 Wertli et al, 9 Kolnick et al, 10 Berman et al, 11 Majithia and Johnson, 12 and Anderka et al 13 b Efficacy of nonpharmacologic remedies has not been demonstrated in clinical trials. Antacids such as aluminum/ magnesium/simethicone formulations (Mylanta) or calcium carbonate (TUMS) can decrease the discomfort and are considered safe in pregnancy as long as women do not exceed the recommended doses and do not take 5 Rey et al, 6 Ali and Egan L, 7 Malfertheiner et al, 8 Wertli et al, 9 Kolnick et al, 10 Berman et al, 11 Majithia and Johnson, 12 and Anderka et al 13 b Efficacy of nonpharmacologic remedies has not been demonstrated in clinical trials.…”

Section: Treatmentmentioning

confidence: 99%

Gastrointestinal Distress in Pregnancy

Zielinski

Searing

Deibel

2015

Journal of Perinatal &Amp; Neonatal Nursing

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Gastrointestinal discomforts are a very common complaint in pregnancy. In fact, most pregnant women will experience at least one discomfort. This article focuses on 5 common conditions that occur in pregnancy: gastroesophageal reflux disease, diarrhea, constipation, hemorrhoids, and pica. While these conditions do occur in men and nonpregnant women, they occur more frequently in pregnancy because of the anatomic and physiologic changes associated with gestation. The type and severity of symptoms can vary from individual to individual, making treatment a challenge for healthcare providers, particularly when caring for pregnant women because the effects of medications and other treatments on the developing fetus are often not extensively studied. While these discomforts are rarely life-threatening, they can cause significant distress and impair quality of life. The goal of this article was to provide a summary of the anatomic and physiological changes during pregnancy that contribute to the increasing incidence of these discomforts and to provide information about each condition including prevalence, symptoms, and treatment modalities.

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“…There are many over-the-counter medicines that contain calcium in their formulation and can be additional sources of calcium for patients who are consuming calcium carbonate. As a consequence of the change from milk to calcium carbonate as the source of calcium in milk alkali syndrome, the demographic risk of developing this syndrome has shifted in the favor of women on calcium carbonate for osteoporosis prophylaxis, heart transplant patients and pregnant women [6][7][8]10].…”

Section: Discussionmentioning

confidence: 99%

Iatrogenic Milk Alkali Syndrome in a Patient Recovering from Acute Renal Failure

Scofield¹

2016

JED

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A 49 year old morbidly obese man, with an extensive past medical history, presented to the emergency department with progressive shortness of breath, and subjective febrile episodes accompanied by chills. He had no complaints of chest pain, diaphoresis, nausea, vomiting, cough, abdominal pain and had negative history related to travel or any unusual immobility. He was hypotensive with a blood pressure of 74/65 mmHg, pulse of 103 bmp, was breathing at 28 per minute, and his recorded temperature was 99.2 F. His past medical history included of type 2 diabetes mellitus, hypertension, and obstructive sleep apnea with tracheostomy and stage 2 Chronic Kidney Disease (CKD) with a baseline serum creatinine of 2.4 mg/ dl. He was admitted with the diagnosis of septic shock supplemented by laboratory evidence of multiple organ failure. He was started on isotonic intravenous fluids along with ceftriaxone and vancomycin after blood cultures were obtained. He had been on 23 prescription medications including furosemide, metolazone, lisinopril and aspirin. Laboratory examination showed serum white blood cell count of 17.8, Blood Urea Nitrogen (BUN) of 50 mg/ dL, serum AbstractWe describe a 49 year old morbidly obese man with iatrogenic milk alkali syndrome. He presented with sepsis resulting in acute renal failure with resultant hyperphosphatemia treated with high dose calcium carbonate. As his renal function improved, the calcium carbonate was continued and he developed high serum calcium with low serum parathyroid hormone. Serum calcium returned to normal with cessation of the calcium carbonate. We performed an extensive literature search that found many case reports and case series recognizing milk alkali syndrome as a common diagnosis of hypercalcemia on presentation. However, hypercalcemia was not a manifestation in our patient on presentation. There is scant literature on the subject of iatrogenic milk alkali syndrome. This complication in a hospitalized patient emphasizes that vigilance is required by the physicians while managing patients with multiple comorbidities, including chronic kidney disease, and numerous medications.

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Hypercalcemia in Pregnancy: A Case of Milk-Alkali Syndrome

Cited by 22 publications

References 28 publications

Maternal Mineral and Bone Metabolism During Pregnancy, Lactation, and Post-Weaning Recovery

Maternal Mineral and Bone Metabolism During Pregnancy, Lactation, and Post-Weaning Recovery

Gastrointestinal Distress in Pregnancy

Iatrogenic Milk Alkali Syndrome in a Patient Recovering from Acute Renal Failure

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