Endocrine Abstracts

Introduction

Milk-Alkali Syndrome is defined by the triad of hypercalcaemia, acute renal failure and metabolic alkalosis. It was first described by Sippy in 1915 after people were treated with the Sippy regimen for peptic ulcer disease.

Case report

A 76 year old woman was referred to the Endocrinology Clinic after she was initially presented to the Gastroenterolgy team with altered bowel habits, hypercalcaemia (serum total calcium 3.09 mmol/l) and suppressed PTH (5 ng/l). She had a 6 month history of constipation alternating with overflow diarrhoea, polydipsia, polyuria, general malaise with “weak legs” and chronic low back pain. Examination did not reveal any pathology. Her repeat corrected Ca level was 3.45 with PTH of 8 and urineCa/urineCr=1.03. Serum biochemistry & electrolytes, FBC, TFTs, cortisol and Vit D levels were all normal. She was admitted for urgent treatment of her hypercalcaemia and she was started on IV fluids & IV Pamidronate 90 mg to which she responded well (corr.Ca post-treatment=2.55). Further investigations were normal (ACE, tumour & inflammatory markers, myeloma & auto-antibody screen, CXR, CT abdomen, bone scan). On further questioning the patient admitted to taking 6-8 CaCarbonate-containing antacid tabs/d (Roche “Rennies”, 1tab=680 mg CaCarbonate) for many years as she was experiencing dyspepsia. She was advised to discontinue the antacid tabs and she was discharged normocalcaemic with corrCa=2.38 mmol/l.

Discussion

This case illustrates that hypercalcaemia may be the sole presenting complaint in patients with milk-alkali syndrome. As in our case, the consumption of large amounts of milk or milk-related products is not necessarily associated with the syndrome. Milk-alkali syndrome is the 3^rd commonest cause of hypercalcaemia, however, the diagnosis may be missed without a detailed drug history.