Milk-Alkali Syndrome Clinical Presentation

Updated: Aug 09, 2017
  • Author: R Hal Scofield, MD; Chief Editor: George T Griffing, MD  more...
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Presentation

History

Milk-alkali syndrome is a diagnosis of history and of exclusion; other potential causes of hypercalcemia must be eliminated. A careful history of all medicines, including OTC medications, should be obtained. This includes actual inspection of bottles to determine ingredients, when needed.

Failure to diagnose milk-alkali syndrome is usually related to a failure to obtain a full history of OTC medications. [38] Moreover, in a series of 11 patients with milk-alkali syndrome, only 5 had the diagnosis made while hospitalized. The remaining 6 were diagnosed only with chart review in retrospect. [13] Patients discharged without a specific diagnosis are likely to continue excess intake of calcium carbonate and develop hypercalcemia again.

Three different progressive stages have been noticed. First, the toxemia (acute) stage occurs within 2-30 days after calcium ingestion begins and clinically patients present with irritability, vertigo, apathy, headaches, weakness, muscle aches, and/or vomiting. Second, the intermediate stage, or Cope syndrome, clinically has the above symptoms along with conjunctivitis. Third, the chronic stage, or Burnett syndrome, manifests as soft tissue calcification including conjunctivitis, band keratopathy of the cornea, musculoskeletal deposits, and nephrocalcinosis. [39]

No specific or characteristic physical findings are described for milk-alkali syndrome; the signs and symptoms are those of hypercalcemia from any cause. Central nervous system symptoms may include the following:

  • Fatigue
  • Depression
  • Malaise
  • Confusion/mental status changes

GI symptoms may include the following:

  • Nausea
  • Vomiting
  • Constipation

Genitourinary symptoms and signs may include the following:

  • Urinary frequency
  • Renal tubular defects
  • Renal failure

Cardiac symptoms and signs may include the following:

  • Electrocardiographic changes (short QT/QTc interval) [40]
  • Hypercalcemia can occasionally produce J (or Osborn) waves, which are typically seen in hypothermia. However, Osborn waves due to hypothermia and other conditions like haloperidol overdose and active cardiac ischemia are associated with prolonged QT/QTc interval in contrast to short QT/QTc interval in hypercalcemia. [4]
  • Arrhythmias