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Milk-alkali syndrome is an increasingly common cause of hypercalcemia, presenting with diverse symptoms. Emergency physicians must consider this diagnosis and review medication history, including over-the-counter antacids, in patients with hypercalcemia.

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Area of Science:

  • Internal Medicine
  • Nephrology
  • Emergency Medicine

Background:

  • Hypercalcemia presents with varied clinical manifestations and etiologies.
  • The incidence of hypercalcemia attributed to milk-alkali syndrome is rising.
  • Milk-alkali syndrome is now a leading cause of hypercalcemia.

Observation:

  • A 26-year-old woman presented with severe myalgias, arthralgias, immobility, nausea, vomiting, abdominal pain, and depression post-cesarean section.
  • These symptoms, along with hypercalcemia, suggested the "stones, bones, moans, and groans" presentation.
  • The patient's condition was linked to excessive calcium carbonate intake.

Findings:

  • The patient was diagnosed with hypercalcemia secondary to milk-alkali syndrome.
  • Symptoms and laboratory findings of hypercalcemia resolved with appropriate management.
  • This case highlights the importance of a comprehensive medication history.

Implications:

  • Emergency physicians must recognize the diverse symptoms of hypercalcemia.
  • A high index of suspicion for milk-alkali syndrome is crucial in hypercalcemia cases.
  • Inquiring about over-the-counter medication use, particularly calcium carbonate, is essential for diagnosis.