Milk-alkali syndrome

Definition

Milk-alkali syndrome is an acquired condition in which there are high levels of calcium (hypercalcemia) and a shift in the body's acid/base balance towards alkaline (metabolic alkalosis).

Causes, incidence, and risk factors

Milk-alkali syndrome is caused by excessive consumption of milk (which is high in calcium) and certain antacids, especially calcium carbonate or sodium bicarbonate (baking soda), over a long period of time.

Calcium deposits in the kidneys and in other tissues can occur in milk-alkali syndrome. Consumption of excessive amounts of vitamin D, which is usually added to milk bought at the supermarket, can worsen this condition.

In the past, milk-alkali syndrome was often a side effect of treating peptic ulcer disease with antacids containing calcium. It is rarely seen today, because newer, better medications are available for treating ulcers. A more common scenario today is when someone takes too much calcium carbonate in an attempt to prevent osteoporosis. This syndrome has been reported in persons who take as little as 2 grams of calcium per day.

Symptoms

The condition usually has no symptoms (asymptomatic). When symptoms do occur, they are often related to complications, such as kidney problems.

Symptoms include:

• Back, middle of the body, and loin pain (related to kidney stones)
• Excessive urination
• Fatigue
• Nausea
• Other problems that can result from kidney failure

Signs and tests

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

• X-rays
• Computed tomography (CT scans)
• Ultrasound

Other tests used to make a diagnosis:

• Electrolyte levels
• Kidney function blood tests
• Blood gas
• Blood calcium level

Treatment

Treatment involves reducing or eliminating milk and other forms of calcium such as in antacids. If severe kidney failure has occurred, the damage may be permanent.

Expectations (prognosis)

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

Complications

The most common complications include:

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

Calling your health care provider

Contact your health care provider if:

• You drink large amounts of milk and you often use antacids.
• You have any symptoms that might suggest kidney problems.

Prevention

Milk-alkali syndrome is now very uncommon because non-antacid treatments for indigestion, gastric ulcers, and peptic ulcer disease have replaced most excessive antacid use.

If you do use antacids often, don't drink large amounts of milk, and tell your doctor about your digestive problems. If you are trying to prevent osteoporosis, do not take more than 1.5 grams of calcium per day.

References

Wysolmerski JJ, Insogna KL. The parathyroid glands, hypercalcemia, and hypocalcemia. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 266.