Unexpected severe hypercalcemia due to Milk-alkali syndrome in a patient with hypoparathyroidism: a case report/ Hipercalcemia grave inesperada devido à síndrome Milk-Alkali em um paciente com hipoparatireoidismo: relato de caso

Authors

  • Aline Faria Silveira
  • Felipe Flach
  • Júlia de Ávila Foresti
  • Laura Somensi Marconi
  • Eduardo Guimarães Camargo

DOI:

https://doi.org/10.34117/bjdv7n4-481

Keywords:

milk-alkali, hypoparathyroidism, hypercalcemia, metabolic alkalosis, renal failure.

Abstract

Milk-alkali syndrome (MAS) is caused by the excessive ingestion of calcium and absorbable alkali, resulting in a characteristic triad of hypercalcemia, metabolic alkalosis, and renal insufficiency. Although MAS is a frequent cause of hypercalcemia, the diagnosis of MAS in patients with postsurgical hypoparathyroidism is not frequently reported, and its real dimensions and severity are not clear in these cases. We report the case of a 77-year-old woman with post thyroidectomy hypoparathyroidism on treatment with usual doses of calcitriol and calcium carbonate who presented with onset of progressive weakness, anorexia, and nausea. Laboratorial evaluation showed marked hypercalcemia (total calcium 19.3 mg/dL, ionized calcium 2.58 mmol/L), metabolic alkalosis, and renal failure. Continuous intravenous hydration was immediately started with 0.9% saline solution, and calcium carbonate and calcitriol were suspended, resulting in progressive clinical and laboratorial improvement within 4 days after starting the treatment. She was diagnosed with MAS and discharged with a treatment for hypoparathyroidism including calcium citrate and calcitriol. Although uncommon, severe hypercalcemia related to MAS can be an unexpected complication in patients with permanent hypoparathyroidism on treatment with the usual dose of calcium carbonate, a source of calcium and alkali. Elderly female patients and those on a thiazide diuretic might be especially vulnerable to development of MAS.

 

 

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Published

2021-04-19

How to Cite

Silveira, A. F., Flach, F., Foresti, J. de Ávila, Marconi, L. S., & Camargo, E. G. (2021). Unexpected severe hypercalcemia due to Milk-alkali syndrome in a patient with hypoparathyroidism: a case report/ Hipercalcemia grave inesperada devido à síndrome Milk-Alkali em um paciente com hipoparatireoidismo: relato de caso. Brazilian Journal of Development, 7(4), 40407–40414. https://doi.org/10.34117/bjdv7n4-481

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Original Papers