Abstract
Background: The ingestion of large amounts of milk and antacids to treat peptic ulcer disease was a common cause of hypercalcemia in the past (the “milk-alkali syndrome”). The current popularity of calcium and supplements has given rise to a similar problem. Objectives: To evaluate the prevalence and characteristics of hypercalcemia induced by calcium intake (“calcium supplement syndrome”; or CSS) in hospitalized patients. Methods: We conducted a retrospective; electronic health record (EHR)-based review of patients with hypercalcemia over a 3-year period. Diagnosis of CSS was based on the presence of hypercalcemia; a normal parathyroid hormone (PTH) level; renal insufficiency; metabolic alkalosis; a history of calcium intake; and documented improvement with treatment. Results: Of the 72 patients with non-PTH mediated hypercalcemia; 15 (20.8%) satisfied all the criteria for the diagnosis of CSS. Calcium; vitamin D; and multivitamin ingestion were significantly associated with the diagnosis (p values < 0.0001; 0.014; and 0.045 respectively); while the presence of hypertension; diabetes; and renal insufficiency showed a trend towards statistical significance. All patients received intravenous fluids; and six (40%) received calcium-lowering drugs. The calcium level at discharge was normal 12 (80%) of patients. The mean serum creatinine and bicarbonate levels decreased from 2.4 and 35 mg/dL on admission respectively; to 1.6 mg/dL and 25.6 mg/dL at discharge respectively. Conclusion: The widespread use of calcium and vitamin D supplementation can manifest as hypercalcemia and worsening of kidney function in susceptible individuals. Awareness among health care professionals can lead to proper patient education regarding these health risks.
Highlights
The milk-alkali syndrome (MAS) is a disorder induced by intake of large amounts of milk, calcium preparations, and alkali for gastric acid neutralization and treatment of ulcer disease [1]
The current day version is a manifestation of hypercalcemia and attendant laboratory abnormalities in predisposed individuals stemming from the widespread use of calcium and vitamin D therapy for osteoporosis or health maintenance [7,8], and is more aptly labeled the “calcium supplement syndrome” (CSS)
The medical records of the remaining 72 patients who had either a normal or low parathyroid hormone (PTH) level were reviewed to further exclude specific causes of hypercalcemia, and to evaluate whether the presentation and the clinical and biochemical features of individual patients could be attributable to CSS
Summary
The milk-alkali syndrome (MAS) is a disorder induced by intake of large amounts of milk, calcium preparations, and alkali for gastric acid neutralization and treatment of ulcer disease [1]. The hallmarks of MAS consist of hypercalcemia, metabolic alkalosis with elevated serum bicarbonate, and renal insufficiency [2]. It was a common cause of hypercalcemia in the past, the incidence of MAS reduced considerably with the decrease in popularity of traditional therapies for ulcer disease. Objectives: To evaluate the prevalence and characteristics of hypercalcemia induced by calcium intake (“calcium supplement syndrome”; or CSS) in hospitalized patients. Diagnosis of CSS was based on the presence of hypercalcemia; a normal parathyroid hormone (PTH) level; renal insufficiency; metabolic alkalosis; a history of calcium intake; and documented improvement with treatment.
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