Endocrine Abstracts

Introduction: Milk – alkali syndrome is a rare and distinctive disorder caused by ingestion of large amounts of calcium and absorbable alkali resulting in hypercalcemia. It is characterized by a triad of hypercalcemia, metabolic alkalosis and renal failure. It was first described in 1920s, as it was mainly caused by administration of milk and bicarbonate for treatment of peptic ulcers. Since the usage of new treatment modalities for peptic ulcer disease, the incidences of milk alkali syndrome have decreased.

Case report: Here we present a 59 years old female patient, who presented to Emergency department for a fall and Syncopal episode. Our patient had few days history of increasing thirst, polyuria and diffuse abdominal discomfort. This prior to her syncopal episode, which lasted for few minutes with quick recovery. She had a past medical history of Endometriosis, Type 2 diabetes mellitus, epilepsy and ex-IVDU user with hep B in remission. She was suffering with frequent episodes of heart burns and self-treated this with over counter Rennie tablets. She had been taking almost 100 Rennie tablets per day and this over few weeks. On admission our patient was found to be confused and dehydrated. she had an adjusted calcium level of 4.55, Phosphate levels of 0.85, Suppressed PTH levels and acute kidney injury. Her Vitamin D levels on admission was 34 with urea of 16.9 and creatinine of 334. She had ECG changes related to the severe hypercalcemia. CT head performed for her syncopal episode did not report any abnormalities. Bence jones proteins, electrophoresis and ACE levels were within normal range. A CT Thorax, Abdomen and Pelvis was reported a 25 mm exophytic low density lesion over the upper pole of the right kidney. Following this an ultrasound was performed and this resulted in simple cyst as the lesion found on the upper pole of the kidney. Her Calcium levels responded well to aggressive Intravenous fluid resuscitations. Her latest calcium levels and renal function are within normal range and she was also imitated on vitamin D therapy.

Conclusion: We would like to emphasise the importance of considering over counter antacids treatment as iatrogenic cause of hypercalcemia, especially severe hypercalcemia like our patients. As mentioned above milk Alkali syndrome is rare nowadays, given new treatment modalities for indigestion and peptic ulcers.