Endocrine Abstracts

Milk Alkali syndrome (MAS), a rare cause of hypercalcaemia, is reversible and caused by the ingestion of large amounts of calcium (Ca) and absorbable alkali. We report a case of MAS in a 37 year old female, admitted with Ca of 3.44 (2.15–2.62 nmol/l). Presenting complaints include 6 months history of worsening fatigue, thirst, polyuria, abdominal pain and a complex background of bipolar disorder, fibromyalgia, spina bifida, lumbar spine fusion and extremely limited mobility. She was taking over-the-counter (OTC) Vitamin D (400 IU)/day. Initial investigations: normal ECG, urea:11.2 (2.5–7.8mmol/l), Creatinine:197 (45–84 μmol/l), eFGR: 25ml/min, appropriately suppressed PTH <1.2 (1.1–4.7 pmol/l) and Vitamin D 58 (50–250 nmol/l). Immunoglobulin electrophoresis: high total Protein 82 (60–80 g/l), IgG 18.80 (7–16 g/l), negative urinary Bence Jones Proteins and LDH. She was treated with i.v normal saline and was discharged with Ca 2.80 mmol/l and improved AKI. CT Thorax Abdomen Pelvis revealed no abnormal findings. However, she was re-admitted within 3 days with symptom recurrence and Ca of 3.01 mmol/l. She was treated with i.v normal saline and Pamidronate. Haematology review ruled out a haematological cause. Further careful history taking revealed patient’s chronic intake of ~2 pints milk/day plus OTC antacids. We believe that her hypercalcaemia was multifactorial in origin. Her habitual milk intake contributed to ~1200 mg/day Ca plus ~300 mg of OTC Ca supplements contributed to the MAS. Her hypercalcaemia was further exacerbated by immobility. She discontinued her excessive milk and antacids intake. Her Ca has been normal since. Our case report emphasises the importance of good history taking in establishing the diagnosis of MAS which is considered uncommon. MAS can cause severe hypercalcaemia warranting hospital admission.