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milk-alkali syndrome (Burnett syndrome)

Hypercalcemia & renal failure in patients ingesting large amounts of calcium. Etiology: 1) ingesting large amounts of dairy products a) vitamin D fortified milk b) cream 2) ingesting large amounts of calcium carbonate for peptic ulcer disease Epidemiology: - 9% of hypercalcemia - 26% of severe hypercalcemia [3] Pathology: 1) metabolic alkalosis limits urinary excretion of Ca+2 2) ingestion of large amounts of Ca+2, results in hypercalcemia 3) renal insufficiency may result from soft tissue calcification of the kidney 4) renal insufficiency inhibits HCO3- excretion worsening alkalosis, perpetuating the cycle Clinical manifestations: 1) anorexia 2) nausea/vomiting 3) irritability 4) headache 5) dizziness 6) depression 7) confusion 8) calcific keratitis 9) periarticular calcinosis 10) renal insufficiency Laboratory: 1) serum calcium: hypercalcemia (may be marked, > 14 mg/dL) 2) normal to increased serum phosphate 3) normal serum alkaline phosphatase 4) normal to decreased urinary calcium 5) mild metabolic alkalosis 6) elevated serum urea nitrogen & serum creatinine (may be marked) 7) serum 1,25-dihydroxyvitamin D is low 8) serum parathyroid hormone is low Special laboratory: - electrocardiogram: shortened QT interval Complications: - nephrolithiasis Management: 1) volume repletion 2) cessation of supplemental calcium & alkali 3) treatment of hypercalcemia with calcitonin 4) furosemide may be used to enhance urinary Ca+ excretion after volume repletion 5) prognosis: renal insufficiency may persist after treatment

Related

calcitonin; contains: katacalcin; calcitonin carboxyl-terminal peptide; CCP; PDN-21 (CALC, CALC1) furosemide (Lasix, Furoscix)

General

metabolic disease syndrome

References

  1. DeGowin & DeGowin's Diagnostic Examination, 6th edition, RL DeGowin (ed), McGraw Hill, NY 1994, pg 911
  2. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
  3. Bazari H, Palmer WE, Baron JM, Armstrong K Case 24-2016 - A 66-Year-Old Man with Malaise, Weakness, and Hypercalcemia. N Engl J Med 2016; 375:567-574. August 11, 2016 PMID: 27509105 http://www.nejm.org/doi/full/10.1056/NEJMcpc1503829