Milk-Alkali Syndrome in a Patient with Postoperative Hypoparathyroidism During Long-Term Maintenance of Calcium Supplementation / 대한내분비외과학회지

Calcium plays a critical role in neuromuscular excitement and other cellular functions. Therefore, extracellular calcium concentration is maintained within a very narrow range through interaction of calcium regulating hormones such as parathyroid hormone, calcitonin, and vitamin D. Thus, symptomatic severe hypercalcemia has rarely occurred in a clinical situation, particularly in patients with hypoparathyroidism. In general, a large amount of calcium and vitamin D should be supplied in order to avoid hypocalcemia in hypoparathyroid patients. A 63-year old female patient was admitted suffering from nausea, vomiting, and weakness for two weeks. She had a history of total thyroidectomy and subsequent permanent hypoparathyroidism and long-term calcium and vitamin D supplementation. For over 10 years she had not changed her daily amount of calcium and vitamin D intake. Her initial serum calcium was 17.5 mg/dL, creatinine was 2.57 mg/dL, and total CO2 was 33.1 meq/L. After thorough examination, we concluded that milk-alkali syndrome was the cause of severe hypercalcemia. Therefore, special pay attention should be paid to aged patients on calcium supplementation in situations of increased risk of dehydration and renal insufficiency, even though the usual amount of calcium intake was unchanged for several years.

A Case of Milk-Alkali Syndrome Due to Calcium Carbonate Overdose / 대한신장학회잡지

Milk-Alkali syndrome can be caused by ingesting large amount of calcium and absorbable alkali. Coincident with promotion of calcium therapy for the treatment of osteoporosis in postmenopausal women and secondary hyperparathyroidism in patients with chronic renal failure, the Milk-Alkali syndrome is now a common cause of hypercalcemia. We experienced a case of a woman who had took calcium for hypoparathyroidism after thyroidectomy (and incidental parathyroidectomy) for thyroid papillary adenocarcinoma. Recently she ingested unusually large amount of calcium (10.8 g/day) for a week mistakenly. She presented voiding difficulty, anorexia and irritability with the triad of hypercalcemia, metabolic alkalosis and acute renal failure. All the metabolic abnormalities were normalized and renal function was improved with fluid and diuretic therapies.

A Case of the Milk-alkali Syndrome During Management of Idiopathic Hypoparathyroidism / 대한내분비학회지

Idiopathic hypoparathyroidism is a relatively rare disease characterized by hypocalcemia and hyperphosphatemia: this is due to a deficiency or a sereretory disorder of the parathyroid hormone without any prior operation nor underlying medical disoder. Calcium carbonate and vitamin D substitution are generally considered as the mainstay of therapy, but these treatments can cause hypercalcemia and hypercalciuria. Persistent ingestion of large amount of calcium carbonate can cause milk-alkali syndrome that is characterized by hypercalcemia, metabolic alkalosis and renal failure. Once a patient is diagnosed with milk-alkali syndrome, withdrawal of calcium carbonate and vitamin D is essential and treatment with saline diuresis and furosemide is the usually effective. In treatmenf of hypoparathyroidism with calcium carbonate and vitamin D substitution, evaluation of serum calcium and urinary calcium excretion is essential to avoid hypercalcemia and ypercalciuria. We concluded that during treatment with calcium carbonate and vitamin D substitution for patients with idiopathic hypoparathyroidism, they should have carefully laboratory monitoring, and they should be made aware of the circumstances influencing calcium metabolism

A Case of the Milk-alkali Syndrome During Management of Idiopathic Hypoparathyroidism / 대한내분비학회지

Idiopathic hypoparathyroidism is a relatively rare disease characterized by hypocalcemia and hyperphosphatemia: this is due to a deficiency or a sereretory disorder of the parathyroid hormone without any prior operation nor underlying medical disoder. Calcium carbonate and vitamin D substitution are generally considered as the mainstay of therapy, but these treatments can cause hypercalcemia and hypercalciuria. Persistent ingestion of large amount of calcium carbonate can cause milk-alkali syndrome that is characterized by hypercalcemia, metabolic alkalosis and renal failure. Once a patient is diagnosed with milk-alkali syndrome, withdrawal of calcium carbonate and vitamin D is essential and treatment with saline diuresis and furosemide is the usually effective. In treatmenf of hypoparathyroidism with calcium carbonate and vitamin D substitution, evaluation of serum calcium and urinary calcium excretion is essential to avoid hypercalcemia and ypercalciuria. We concluded that during treatment with calcium carbonate and vitamin D substitution for patients with idiopathic hypoparathyroidism, they should have carefully laboratory monitoring, and they should be made aware of the circumstances influencing calcium metabolism

A Case of the Milk-Alkali Syndrome / 대한신장학회잡지

A resurgence of milk-alkali syndrome is attributable to increases in calcium therapy for the treatment of osteoporosis in postmenopausal women and hyperphosphatemia in chronic renal failure. In Korea, traditionally ox's bone extract is used to treatment of arthralgia, degenerative arthritis, and nutritional supplements. We treated one woman who presented with the triad of hypercalcemia, metabolic alkalosis, and renal failure after ingestion of ox's bone extract. All metabolic abnormalities were normalized, and renal function improved with supportive measures and cessation of ox's bone extract.