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Milk-alkali syndrome

Calcium-alkali syndrome; Cope syndrome; Burnett syndrome; Hypercalcemia; Calcium metabolism disorder

Milk-alkali syndrome is a condition in which there is a high level of calcium in the body (hypercalcemia). This causes a shift in the body's acid/base balance toward alkaline (metabolic alkalosis). As a result, there can be a loss of kidney function.

Causes

Milk-alkali syndrome is almost always caused by taking too many calcium supplements, usually in the form of calcium carbonate. Calcium carbonate is a common calcium supplement. It is often taken to prevent or treat bone loss (osteoporosis). Calcium carbonate is also an ingredient found in antacids (such as Tums).

A high level of vitamin D in the body, such as from taking supplements, can worsen milk-alkali syndrome.

Calcium deposits in the kidneys and in other tissues can occur in milk-alkali syndrome.

Symptoms

In the beginning, the condition usually has no symptoms (asymptomatic). When symptoms do occur, they can include:

  • Back, middle of the body, and low back pain in the kidney area (related to kidney stones)
  • Confusion, strange behavior
  • Constipation
  • Depression
  • Excessive urination
  • Fatigue
  • Irregular heartbeat (arrhythmia)
  • Nausea or vomiting
  • Other problems that can result from kidney failure

Exams and Tests

Calcium deposits within the tissue of the kidney (nephrocalcinosis) may be seen on:

Other tests used to make a diagnosis may include:

Treatment

In severe cases, treatment involves giving fluids through the vein (by IV). Otherwise, treatment involves drinking fluids along with reducing or stopping calcium supplements and antacids that contain calcium. Vitamin D supplements also need to be reduced or stopped.

Outlook (Prognosis)

This condition is often reversible if kidney function remains normal. Severe prolonged cases may lead to permanent kidney failure requiring dialysis.

Possible Complications

The most common complications include:

  • Calcium deposits in tissues (calcinosis)
  • Kidney failure
  • Kidney stones

When to Contact a Medical Professional

Contact your health care provider if:

  • You take a lot of calcium supplements or you often use antacids that contain calcium, such as Tums. You may need to be checked for milk-alkali syndrome.
  • You have any symptoms that might suggest kidney problems.

Prevention

If you use calcium-containing antacids often, tell your provider about digestive problems. If you are trying to prevent osteoporosis, do not take more than 1.2 grams of calcium per day unless instructed by your provider.

References

Bringhurst FR, Demay MB, Kronenberg HM. Hormones and disorders of mineral metabolism. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology. 13th ed. Philadelphia, PA: Elsevier; 2016:chap 28.

DuBose TD. Metabolic alkalosis. In: Gilbert SJ, Weiner DE, eds. National Kidney Foundation Primer on Kidney Diseases. 7th ed. Philadelphia, PA: Elsevier; 2018:chap 14.

McNutt MK, Kozar RA. Disorders of calcium and magnesium metabolism. In: Vincent J-L, Abraham E, Moore FA, Kochanek PM, Fink MP, eds. Textbook of Critical Care. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 106.

Smogorzewski MJ, Stubbs JR, Yu ASL. Disorders of calcium, magnesium, and phosphate balance. In: Skorecki K, Chertow GM, Marsden PA, Taal MW, Yu ASL, eds. Brenner and Rector's The Kidney. 10th ed. Philadelphia, PA: Elsevier; 2016:chap 19.

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          Review Date: 10/26/2017

          Reviewed By: Walead Latif, MD, nephrologist and Clinical Associate Professor, Rutgers Medical School, Newark, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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