Endocrine Abstracts

Introduction: Milk-alkali syndrome (MAS) consists of hypercalcemia, renal failure, and metabolic alkalosis as a result of ingestion of large amounts of calcium and absorbable alkali. Daily elemental calcium intake of no more than 2 g is considered safe. However, even doses lower than 2 g daily may result in hypercalcemia if additional predisposing factors are present. Vulnerable patients because of vomiting, diuretic use, and deviant eating habits. In these susceptible patient groups, supplementing calcium in a form that contains no absorbable alkali is probably a safer.

Case Presentation: We report a case of a 70 -year-old woman presented in September 2021 with sever lower abdominal pain and confusion. She was diagnosed with acute pancreatitis precipitated by hypercalcemia. Her past medical history of hypertension, gastroesophageal reflux disease. Her regular medications are Atorvastatin and Ramipril. Her husband stated that she has been taking over the counter Deflatine tablets “like sweets” for at least 2 years as an antacid (Deflatine or Rennie tablets contain calcium carbonate and magnesium carbonate). On admission she was found to have very high serum adjusted calcium at 4 mmol/l (2.20 – 2.60), acute kidney injury with EGFR of 15 (her base line EGFR prior to admission was 45) and significantly high lipase and amylase. Her parathyroid hormone PTH level was on the low side at 1 pmol/l (1.3 - 7.3). 25 OH total vitamin D level was 42 nmol/l. CT chest, abdomen and pelvis confirmed the diagnosis of acute pancreatitis, there was no evidence of malignancy or gall stones. She recovered very well with hydration and supportive treatment. Her calcium level normalized after stopping of Deflatine tablets and remained normal up to date.

Conclusion: MAS is believed to be the third most common cause of in-hospital hypercalcemia, after hyperparathyroidism and malignant neoplasms. Hypercalcemia can be severe and, in our patient, caused acute pancreatitis. Renal failure is generally reversible, but impairment in renal function may persist in some cases. Treatment is supportive and involves hydration and withdrawal of the offending agents. Physicians and the public need to be aware of the potential adverse effects of ingesting excessive amounts of calcium carbonate.