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Milk-alkali syndrome in pregnancy
Michalis K Picolos1, Charles R Sims, Joan M Mastrobattista
1Department of Internal Medicine, Division of Endocrinology, Diabetes, and Metabolism, The University of Texas Medical School at Houston, Houston, Texas, USA. Michalis.K.Picolos@uth.tmc.edu
Background:
Severe hypercalcemia, a potentially life-threatening medical emergency, is rare in pregnancy.
Case:
We report a 32-year-old woman presenting early in the second trimester with severe hypercalcemia (total calcium 22 mg/dL), alkalosis, and acute renal insufficiency resulting from excessive ingestion of calcium carbonate-containing antacid for gastroesophageal reflux. The patient was treated with aggressive hydration and furosemide, and received 1 dose of intravenous etidronate, leading to short-term symptomatic hypocalcemia. To our knowledge, this is the third reported case of milk-alkali syndrome in pregnancy.
Conclusion:
Milk-alkali syndrome is an uncommon cause of hypercalcemia in pregnancy. Intravenous hydration with saline should be the cornerstone of treatment, reserving bisphosphonates for selected cases.