Endocrine Abstracts

A 59 year old female patient presented with fall and Syncopal episode to Emergency Department. She had a few days history of increasing thirst, polyuria and diffuse abdominal discomfort. These symptoms were ongoing for weeks prior to her syncopal episode. Her past medical history of Endometriosis, Type 2 diabetes mellitus, epilepsy, ex-IVDU user with hep B in remission and self-neglect. She suffered 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 very 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 and this was reported as n abnormalities found. 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: Her Acute kidney injury, metabolic alkalosis and severe hypercalcaemia was a result of Milk Alkali syndrome secondary to over counter antacid tablets-Rennies. Our patient was taking upto hundred tablets on daily basis for two to three weeks prior to her acute admission. We would like to emphasise the importance of considering over counter antacids treatment as iatrogenic cause of hypercalcemia, especially severe hypercalcemia like our patients. Milk Alkali syndrome is rare nowadays, given new treatment modalities for indigestion and peptic ulcers. However, with this case we would conclude Milk Alkali syndrome should also be included as part of differential diagnosis of Hypercalcaemia.