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The milk-alkali syndrome

Alan S L Yu, MB, BChir
Jason R Stubbs, MD
Section Editor
Stanley Goldfarb, MD
Deputy Editor
Albert Q Lam, MD


The milk-alkali syndrome consists of the triad of hypercalcemia, metabolic alkalosis, and acute kidney injury associated with the ingestion of large amounts of calcium and absorbable alkali. The syndrome was originally described in association with the use of milk and sodium bicarbonate for the treatment of peptic ulcer disease [1]. Once a classic cause of hypercalcemia, the milk-alkali syndrome virtually disappeared with the advent of new therapies of peptic ulcer disease and, by 1985, was considered the cause of less than one percent of cases of hypercalcemia [2].

However, there has since been a resurgence of this disorder, and it may account for up to 12 percent of cases, making it the third leading cause of hypercalcemia behind primary hyperparathyroidism and malignancy [3,4]. (See "Etiology of hypercalcemia".)

Three factors are responsible for this increase in incidence:

The emphasis on calcium therapy for the prevention and treatment of osteoporosis.

Readily available over-the-counter calcium carbonate preparations.

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Literature review current through: Nov 2017. | This topic last updated: Mar 11, 2016.
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