milk-alkali syndrome (Burnett syndrome)
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Introduction
Hypercalcemia & renal failure in patients ingesting large amounts of calcium.
Etiology
- ingesting large amounts of dairy products
- ingesting large amounts of calcium carbonate for peptic ulcer disease
Epidemiology
- 9% of hypercalcemia
- 26% of severe hypercalcemia[3]
Pathology
- metabolic alkalosis limits urinary excretion of Ca+2
- ingestion of large amounts of Ca+2, results in hypercalcemia
- renal insufficiency may result from soft tissue calcification of the kidney
- renal insufficiency inhibits HCO3- excretion worsening alkalosis, perpetuating the cycle
Clinical manifestations
- anorexia
- nausea/vomiting
- irritability
- headache
- dizziness
- depression
- confusion
- calcific keratitis
- periarticular calcinosis
- renal insufficiency
Laboratory
- serum calcium: hypercalcemia (may be marked, > 14 mg/dL)
- normal to increased serum phosphate
- normal serum alkaline phosphatase
- normal to decreased urinary calcium
- mild metabolic alkalosis
- elevated serum urea nitrogen & serum creatinine (may be marked)
- serum 1,25-dihydroxyvitamin D is low
- serum parathyroid hormone is low
Diagnostic procedures
- electrocardiogram: shortened QT interval
Complications
Management
- volume repletion
- cessation of supplemental calcium & alkali
- treatment of hypercalcemia with calcitonin
- furosemide may be used to enhance urinary Ca+ excretion after volume repletion
- prognosis: renal insufficiency may persist after treatment
More general terms
Additional terms
- calcitonin; contains: katacalcin; calcitonin carboxyl-terminal peptide; CCP; PDN-21 (CALC, CALC1)
- furosemide (Lasix, Furoscix)
References
- ↑ DeGowin & DeGowin's Diagnostic Examination, 6th edition, RL DeGowin (ed), McGraw Hill, NY 1994, pg 911
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
- ↑ 3.0 3.1 Bazari H, Palmer WE, Baron JM, Armstrong K Case 24-2016 - A 66-Year-Old Man with Malaise, Weakness, and Hypercalcemia. N Engl J Med 2016; 375:567-574. August 11, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27509105 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMcpc1503829