MILK-ALKALI SYNDROME, A RARE CAUSE OF HYP ERCALCEMIA

History and clinical findings: A 54-year-old man was hospitalised beca use hypercalcaemia and associated renal failure were suspected. He had a history suggesting gastric ulcer, with nonspecific back and shoulde r pain and spontaneously passed kidney stone. On admission the patient reported reduction in physical fitness, fatigue, headache and nausea without vomiting. Physical examination was unremarkable except for pai n on pressure over the thoracic and lumbar vertebrae. Investigations: Hypercalcaemia of 3.9 mmol/l was found while parathormone was low. Ser um creatinine concentration was 2.8 mg/dl. Malignancy was excluded aft er extensive tests. A florid gastric ulcer was demonstrated, together with Helicobacter pylori infection. Computed tomography revealed stipp led calcifications in the kidneys. Treatment and course: Renal functio n markedly improved, the hypercalcaemia disappeared and the parathormo ne level rose within four days of the administration of sodium chlorid e (2.5 \daily of a 0.9% solution) and of furosemide (40 mg daily). Rep eat questioning of the patient revealed that because of stomach pains he had for four years been taking up to 6 g calcium carbonate daily in the form of a prescription-free antacid. He was thereupon treated for a milk-alkali syndrome. Calcium concentration became normal, while re nal function has remained slightly impaired a year later. The ulcer ha s healed without recurrence on eradication of the Helicobacter pylori infection with amoxicillin and omeprazole. Conclusions: The danger of some >>over the counter<< prescription-free medications should not be underestimated and patients should be routinely questioned about them. Absorbable antacids should no longer be taken in the treatment of pep tic complaints now that effective antacids, H-2-receptor antagonists a nd proton-pump inhibitors have become available.