Milk-Alkali Syndrome

Written by Ann Pietrangelo | Published on September 16, 2012
Medically Reviewed by George Krucik, MD

What Is Milk-Alkali Syndrome?

Milk-alkali syndrome is a condition characterized by high levels of calcium in the blood and a disruption in the body’s acid/base balance, shifting toward excess alkali (base). Too much calcium in the bloodstream is called hypercalcemia.

In the past, this condition was commonly caused by taking antacids containing calcium in combination with drinking large amounts of milk over a long period. However, over-ingestion of calcium supplements taken in conjunction with other medications that contain calcium carbonate is more likely to cause this condition today.

Excess calcium in the blood may be deposited in the kidneys. This can trigger symptoms such as excessive urination and fatigue. Over time, this condition can lead to serious complications, including kidney stones and kidney failure.

According to Medscape, the early symptoms of milk-alkali syndrome are often vague. In many cases, the condition goes undiagnosed as a result. Because of this delayed diagnosis, people often continue taking excess calcium carbonate, putting them at greater risk for complications. (Medscape, 2012)

The condition usually improves when you cut down on or eliminate antacids or high-dose calcium supplements.

Causes of Milk-Alkali Syndrome

Milk-alkali syndrome was once a common side effect of consuming large amounts of milk or milk products in conjunction with antacids that contain calcium.

Today, this condition is most often caused by over-ingestion of calcium carbonate—a dietary supplement that is taken when a person does not get enough calcium in their diet. Calcium supplements are available in two forms: carbonate and citrate. According to the National Institutes of Health Office of Dietary Supplements (NIHODS), calcium carbonate is more popular because it is less expensive and more convenient to take (NIHODS, 2012).

Many over-the-counter antacids, such as Tums and Maalox, also contain calcium carbonate. Milk-alkali syndrome often results when people do not realize that they are ingesting too much calcium by taking multiple supplements or medications that contain calcium carbonate.

Symptoms of Milk-Alkali Syndrome

Often, there are no noticeable symptoms. Symptoms, when they occur, are usually caused by kidney problems and can include:

  • high urine output
  • fatigue
  • nausea
  • pain in the abdomen, back, or loin due to kidney stones

Diagnosing Milk-Alkali Syndrome

Your doctor can typically diagnose this condition with a complete physical exam and blood tests. Talk to you doctor about any symptoms you are experiencing. Provide a complete list of all prescription and over-the-counter medications and supplements you are taking. This condition is often misdiagnosed due to failure to obtain a full history of medications (Medscape, 2012).

Your doctor will likely order a blood test to determine the level of calcium in your blood. A normal amount ranges from 8.5 to 10.2 milligrams per deciliter of blood. Higher levels may indicate milk-alkali syndrome.

If left untreated, this condition can lead to calcium deposits in the kidneys. Your doctor may order additional imaging tests to rule out or diagnose complications in the kidneys. These tests may include:

  • CT scans
  • X-rays
  • ultrasounds
  • kidney function testing

Early diagnosis can prevent permanent damage to your kidneys.

Treating Milk-Alkali Syndrome

The goal of treatment is to reduce the amount of calcium in your diet. Complications, such as kidney stones and kidney damage, will also have to be treated. If you are currently taking calcium supplements or antacids for a specific medical condition, ask your doctor if there is an alternative treatment.

Long-Term Outlook

After eliminating or reducing your calcium intake, the prognosis is very good.

Untreated milk-alkali syndrome and continuous, long-term ingestion of large amounts of calcium may lead to serious complications, including:

  • calcium deposits in body tissues
  • kidney stones
  • kidney failure


You can avoid developing milk-alkali syndrome by:

  • limiting or eliminating your use of antacids that contain calcium
  • asking your doctor about antacid alternatives
  • limiting doses of supplemental calcium carbonate
  • reporting digestive problems to your doctor

Recommended Dietary Allowances of Calcium

The Office of Dietary Supplements lists recommended daily allowances for calcium (the average level necessary to meet the needs of most healthy individuals) as follows:

  • 0 to 6 months of age: 200 mg
  • 7 to 12 months: 260 mg
  • 1 to 3 years: 700 mg
  • 4 to 8 years: 1,000 mg
  • 9 to 18 years: 1,300 mg
  • 19 to 50 years: 1,000 mg
  • 51 to 70: 1,000 for males, 1,200 mg for females
  • 71+ years: 1,200 mg

According to the National Center for Biotechnology Information (NCBI), taking 2,000 milligrams or more of calcium each day increases risk for hypercalcemia. (NCBI, 2012)

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