Milk-alkali syndrome

Magnesium administration (IV, enteral, and enemas) ° Milk-alkali syndrome... 

Antacids containing calcium carbonate have the greatest neutralising capacity but tend to cause acid rebound with long-term use. Calcium carbonate may also lead to hypercalcaemia and the milk-alkali syndrome, which is characterised by nausea, headache and renal damage. 

Milk-alkali syndrome Milk-alkali syndrome, an acute illness with symptoms of headache, nausea, irritability, and weakness, or a chronic illness with alkalosis, hypercalcemia and, possibly, renal impairment, has occurred following the concurrent use of high-dose calcium carbonate and sodium bicarbonate. Hypophosphatemia Prolonged use of aluminum-containing antacids may result in hypophosphatemia in normophosphatemic patients if phosphate intake is not adequate. 

Antacids - Dose-dependent rebound hyperacidity and milk-alkali syndrome. 

When large doses of NaHCOs or CaCOs are given the milk-alkali syndrome can occur as a result from the absorption of too much Ca + and alkali. 

Calcium carbonate Milk-alkali syndrome (headache, decreased appetite, nausea, vomiting, unusual tiredness)... 

Milk-alkali syndrome (may result from excessive antacid use) confusion, headache, nausea, vomiting, anorexia, urinary stones, hypercalcemia... 

AccessMedicine Print Chapter 62. Drugs Used in the Treatment of Gastrointestinal Diseases alkalosis (milk-alkali syndrome). 

The physician is concerned with at least three factors when prescribing antacids (1) Acid rebound (associated with calcium carbonate) (2) milk-alkali syndrome (caused by ingestion of large quantities of alkali) and (3) phosphorus depletion (by aluminum salts). The mechanism of add rebound, especially in the long-term use of caldum carbonate, is poorly understood. It has been established that there is an excessive re-addification of the antrum (pylonc gland area) a number of hours after ingestion of calcium caibonate. 

Hypercalcemia causes central nervous system depression, including coma, and is potentially lethal. Its major causes (other than thiazide therapy) are hyperparathyroidism and cancer with or without bone metastases. Less common causes are hypervitaminosis D, sarcoidosis, thyrotoxicosis, milk-alkali syndrome, adrenal insufficiency, and immobilization. With the possible exception of hypervitaminosis D, these latter disorders seldom require emergency lowering of serum calcium. A number of approaches are used to manage the hypercalcemic crisis. 

Calcium carbonate(eg, Turns, Os-Cal) is less soluble and reacts more slowly than sodium bicarbonate with HC1 to form carbon dioxide and CaCl2. Like sodium bicarbonate, calcium carbonate may cause belching or metabolic alkalosis. Calcium carbonate is used for a number of other indications apart from its antacid properties (see Chapter 42 Agents That Affect Bone Mineral Homeostasis). Excessive doses of either sodium bicarbonate or calcium carbonate with calcium-containing dairy products can lead to hypercalcemia, renal insufficiency, and metabolic alkalosis (milk-alkali syndrome). 

Long-term use of calcium salts can cause the milk-alkali syndrome and alkalosis in conjunction with hypercalcemia and renal insufficiency (6). It presents acutely with headache, nausea, irritability, and weakness, or chronically with uremia, alkalosis, and hypercalcemia. Sustained high dosage and/or concurrent renal disease are common antecedents (7). 

Orwoll ES. The milk-alkali syndrome current concepts. Ann Intern Med 1982 97 242-248. 

Long-term use can cause milk alkali syndrome, with nausea, headache and possibly renal damage... 

J. S. Duthie, H. P. Solanki, M. Knshnamurthy, et al. Milk-alkali syndrome with metastatic calcification. American Journal of Medicine 99, 102 (1995). 

Lithium therapy Hypothyroidism Milk-alkali syndrome Addison s disease Viral hepatitis... 

Metabolic alkalosis may also be generated by the gain of exogenous alkali. This may be seen as a result of bicarbonate administration or from the infusion of organic anions that are metabolized to bicarbonate, such as acetate, lactate, and citrate. The milk-alkali syndrome was historically a common cause of metabolic alkalosis in patients with peptic ulcer disease secondary to the ingestion of large quantities of milk products and antacids. This syndrome has become increasingly uncommon with the advent of alternative effective therapies for dyspeptic syndromes. 

Excess mineralocorticoid activity Hyperaldosteronism Cushing s syndrome Bartter s syndrome Gitelman s syndrome Excessive black licorice intake Profound potassium depletion Magnesium deficiency Liddle s syndrome Unclassified Alkali administration Milk-alkali syndrome... 

R7, Rifkind, B. M., Ghazan, B. I., and Aitchison, J. D., Ghronic milk-alkali syndrome with generalised osteosclerosis after prolonged excessive intake of Rennie s tablets. Brit. Med. J. I, 317-320 (1960). 

Milk alkali syndrome the combination of an increased calcium intake together with bicarbonate, as in a patient self medicating with proprietary antacid, may cause severe hypercalcaemia. but the condition is very rare. 

Caicium Carbonate (1 Constipation, hypercalcemia, metabolic alMosis, hemorrhoids, bleeding anal fissures. Rarely, milk-alkali syndrome (if taken chronically with milk or bicarbonate). 

The thiazide diuretics (and triamterene) can cause calcium retention by reducing its urinary excretion. This, added to the increased intake of calcium, resulted in excessive calcium levels. Alkalosis (the milk-alkali syndrome, associated with hypercalcaemia, alkalosis, and renal impairment) may also occur in some individuals because the thiazide limits the excretion of bicarbonate. 

Hypercalcaemia, alkalosis and renal insufficiency (milk-alkali syndrome) can develop in patients taking antacids with calcium-containing substances, including dairy products. 

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