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Hypoventilation: a risk factor for milk alkali syndrome?
Felix Burkhalter1, Christian Forster, Michael Dickenmann
1Department of Nephrology, Universitätsspital Basel, Basel, Switzerland. fburkhalter@uhbs.ch
BMJ Case Reports
|July 17, 2012
Summary
Milk alkali syndrome (MAS) can be triggered by morphine overdose, leading to hypercalcaemia. Hypoventilation may be a risk factor for developing MAS, especially when combined with vomiting and increased bicarbonate intake.
Area of Science:
- Nephrology
- Toxicology
- Internal Medicine
Background:
- Milk alkali syndrome (MAS) is a potentially life-threatening condition characterized by hypercalcaemia, metabolic alkalosis, and renal insufficiency.
- Traditionally associated with excessive intake of calcium and absorbable alkali, MAS can present with varied etiologies.
Observation:
- A 67-year-old woman presented with altered mental status, nausea, and vomiting following an increase in intrathecal morphine dosage.
- Clinical evaluation revealed severe hypercalcaemia, diagnosed as MAS.
Findings:
- The patient's symptoms resolved rapidly upon correction of hypercalcaemia.
- In this case, morphine overdose-induced vomiting caused volume contraction, exacerbating pre-existing chronic compensatory elevation of bicarbonate due to hypoventilation, thereby triggering MAS.
- Ingested carbonate was identified as the primary source of bicarbonate.
Implications:
- This case highlights morphine overdose and hypoventilation as potential triggers for MAS.
- It underscores the importance of considering MAS in patients with hypercalcaemia, especially those with risk factors such as altered respiratory status and increased alkali intake.
- Recognizing these triggers can aid in timely diagnosis and management, preventing severe complications.
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