Journal of General Internal Medicine

, Volume 22, Issue 7, pp 1053–1055 | Cite as

Health-Behavior Induced Disease: Return of the Milk-Alkali Syndrome

  • Joseph B. Caruso
  • Rajendrakumar M. Patel
  • Karan Julka
  • David C. Parish
Case Reports/Clinical Vignettes

Abstract

The milk-alkali syndrome is a well-documented consequence of excessive calcium and alkali intake first recognized in association with early 20th century antacid regimens. The syndrome became rare after widespread implementation of modern peptic ulcer disease therapies. With recent trends in osteoporosis therapy coupled with widely available calcium-containing supplements, the milk-alkali syndrome has reemerged as an important clinical entity. Our case illustrates a patient who self-medicated his peptic ulcer disease with a regimen resembling a common early 20th century dyspepsia regimen. When superimposed upon chronic high calcium supplementation, the patient became acutely ill from the milk-alkali syndrome. When taken to excess, or used inappropriately, medications and supplements ordinarily considered beneficial, can have harmful effects. Our case underscores the importance of obtaining a thorough medication history including use of over-the-counter supplementation.

KEY WORDS

milk-alkali syndrome health behavior hypercalcemia calcium supplementation 

Notes

Conflict of Interest Statement

None disclosed.

References

  1. 1.
    Cooke AM. Alkalosis occurring in the alkaline treatment of peptic ulcers. Quart J Med. 1932;25:527.Google Scholar
  2. 2.
    Sippy BW. Gastric and duodenal ulcer: medical cure by an efficient removal of gastric juice corrosion. JAMA. 1915;64:1625.Google Scholar
  3. 3.
    Grundfast MB, Still CD, Komar MJ. Hypercalcemia and peptic ulcer disease-related milk-alkali syndrome. Nutr Clin Prac. 2003.Google Scholar
  4. 4.
    Gordon MV, Hamblin PS, McMahon LP. Life-threatening milk-alkali syndrome resulting from antacid ingestion during pregnancy. MJA. 2005;182(7):350–1.PubMedGoogle Scholar
  5. 5.
    Orwoll ES. The milk-alkali syndrome: current concepts. Ann Intern Med. 1982;97:242–8.PubMedGoogle Scholar
  6. 6.
    McMillan DE, Freeman RB. The milk alkali syndrome: a study of the acute disorder with comments on the development of the chronic condition. Medicine. 1965;44:485–501.PubMedCrossRefGoogle Scholar
  7. 7.
    Muldowney WP, Mazbar SA. Rolaids-yogurt syndrome: a 1990s version of milk-alkali syndrome. Am J Kidney Dis. 1996;27(2):270–2.PubMedGoogle Scholar
  8. 8.
    Beall DP, Scofield RH. Milk-alkali syndrome associated with calcium carbonate consumption. Medicine. 1995;74:89.PubMedGoogle Scholar
  9. 9.
    Jacobs TP, Bilezikian JP. Rare causes of hypercalcemia. J Clin Endocrinol Metab. 90(11):6316–22.Google Scholar
  10. 10.
    Wu K, Chuang R, Wu FL, et al. The milk-alkali syndrome caused by betelnuts in oyster shell paste. Clin Toxicol. 1996;34(6):741–5.Google Scholar
  11. 11.
    Norton SA. Betel: consumption and consequences. J Clin Endocrinol Metab. 1998;38(1):81–8, Jan.Google Scholar
  12. 12.
    Kallner G, Karlsson H. Recurrent factitious hypercalcemia. Am J Med. 1987;82:536–8.PubMedGoogle Scholar
  13. 13.
    Frame B, Jackson G, Kleerekoper M, Rao D, DeLorenzo A, Garcia M. Acute severe hypercalcemia a la Munchausen. Am J Med. 1981;70:316–9.PubMedGoogle Scholar

Copyright information

© Society of General Internal Medicine 2007

Authors and Affiliations

  • Joseph B. Caruso
    • 1
  • Rajendrakumar M. Patel
    • 1
  • Karan Julka
    • 1
  • David C. Parish
    • 1
  1. 1.Department of Internal MedicineMercer University School of MedicineMaconUSA

Personalised recommendations