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Diagnosing acid-base imbalances involves systematically analyzing arterial blood samples, focusing on three key measurements: pH, bicarbonate (HCO3−) concentration, and carbon dioxide partial pressure (PCO2). This analysis follows a four-step process that helps identify the imbalance's underlying cause and nature.
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Milk-alkali syndrome: a 'quick ease' or a 'long-lasting problem'.

Mawson Wang1, Catherine Cho1, Callum Gray1

  • 1Nepean Blue Mountains Local Health District, Katoomba, New South Wales, Australia.

Endocrinology, Diabetes & Metabolism Case Reports
|May 15, 2020
PubMed
Summary

Milk-alkali syndrome (MAS) is a critical cause of severe hypercalcaemia, often missed. Prompt diagnosis by reviewing patient history is key to avoiding dangerous treatments like bisphosphonates, which can cause hypocalcaemia.

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Area of Science:

  • Nephrology
  • Endocrinology
  • Internal Medicine

Background:

  • Hypercalcaemia is a common electrolyte disturbance.
  • Milk-alkali syndrome (MAS) is an underrecognized cause of hypercalcaemia.
  • MAS can be precipitated by excessive calcium and alkali intake.

Purpose of the Study:

  • To report a case of severe hypercalcaemia due to MAS.
  • To highlight the diagnostic importance of a detailed patient history.
  • To discuss the pathophysiology and clinical significance of MAS.

Main Methods:

  • Case report of a 65-year-old female with symptomatic hypercalcaemia.
  • Clinical presentation included confusion, myalgias, and abdominal discomfort.
  • Diagnosis of MAS was suggested by history of antacid use.

Main Results:

  • The patient presented with corrected calcium of 4.57 mmol/L and metabolic alkalosis.
  • Investigations ruled out malignancy and primary hyperparathyroidism.
  • Treatment with i.v. fluids and bisphosphonate led to hypocalcaemia, requiring calcium replacement.

Conclusions:

  • MAS is the third most common cause of hypercalcaemia.
  • Early recognition of MAS is crucial to prevent complications.
  • Avoiding calcium-lowering therapy like bisphosphonates can prevent iatrogenic hypocalcaemia.