Milk-Alkali Syndrome

"Stones, bones, groans, and psychiatric overtones" is a phrase often used to describe the signs and symptoms of hypercalcemia. Most commonly manifested from malignancy or hyperparathyroidism, the third most common cause of hypercalcemia is milk-alkali syndrome.

Milk-alkali syndrome, also known as calcium-alkali syndrome, is now mostly caused by patients taking calcium carbonate (think Tums) in addition to supplementing with other forms of calcium vitamins. When a patient takes in a large amount of oral calcium, their PTH level decreases, in turn increasing the gut's reabsorption of bicarbonate. This excess bicarbonate combined with further ingestion of calcium leads to hypercalcemia.

The danger of milk-alkali syndrome is when the serum calcium complexes with phosphate and deposits in the kidney, possibly leading to irreversible renal damage. Treatment includes decreasing the amount of calcium ingested daily to around 1200 mg and changing to a form of supplementation other than calcium carbonate. Adequate hydration also helps lower serum calcium levels.