THE MILK-ALKALI SYNDROME CAUSED BY BETELNUTS IN OYSTER SHELL PASTE

Background: The carcinogenic effect of betelnut chewing leading to ora l cancer is well known. Betelnut chewing may also affect the autonomic nervous system. In this report, we present another potential hazard o f betelnuts, milk-alkali syndrome. Case Report: Two patients who had c hewed a large quantity of betelnuts developed hypercalcemia, metabolic alkalosis, and renal insufficiency. They ingested a large amount of c alcium carbonate from a local special paste used for betelnut preparat ion, the main ingredient of which is ground oyster shell. The symptoms and metabolic abnormalities disappeared promptly after abstinence fro m betelnut chewing and administration of saline solution. Improvement of renal function was observed in both patients. Analysis of the calci um content of the paste suggested that the patients might have ingeste d 9 g and 6 g of calcium carbonate per day, respectively. Conclusion: This is the first report of milk-alkali syndrome not caused iatrogenic ally, but by recreational usage of oyster shell preparations of beteln uts.