AACE endocrinology and diabetes · 2025
The Hidden Threat of Antacid Overuse: A Case of Severe, Slow-Burning Hypercalcemia (Serum Calcium of 22.8 mg/dl).
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Shanthosh Kumar Sandhya, Yasnain Sani, Tanveer Saira, Manivannan Niveditha
Аннотация
BACKGROUND/OBJECTIVE: Severe hypercalcemia presents with significant symptoms and life-threatening systemic effects. This case report highlights a rare presentation of severe hypercalcemia due to milk-alkali syndrome (MAS) with surprisingly mild symptoms.
CASE REPORT: A 44-year-old woman presented to the emergency department following a fall that occurred due to losing balance while attempting to pick up her medications that had fallen on the floor, resulting in right fibula fracture. She was incidentally found to have severe hypercalcemia with a serum calcium level of 22.8 mg/dL, despite having only mild symptoms such as brain fog and occasional nausea. Laboratory workup revealed acute kidney injury, metabolic alkalosis and a suppressed parathyroid hormone in the setting of excess intake of calcium carbonate tablets for uncontrolled gastroesophageal reflux disease. This, combined with the clinical and laboratory findings, led to a diagnosis of MAS. The patient was treated with aggressive intravenous fluid hydration and calcitonin, which rapidly improved her severe hypercalcemia.
DISCUSSION: MAS is resurfacing as one of the leading causes of hypercalcemia. This resurgence is particularly relevant given the widespread use of calcium-alkali agents for management of osteoporosis, chronic kidney disease, and gastroesophageal reflux disease. The syndrome can present with mild or nonspecific symptoms which makes diagnosis challenging, especially in patients with complex comorbidities. Awareness of MAS is critical for timely identification and treatment.
CONCLUSION: MAS should be considered a key differential diagnosis in patients with hypercalcemia. Early detection and intervention are essential to reverse metabolic disturbances and prevent potentially life-threatening outcomes.
CASE REPORT: A 44-year-old woman presented to the emergency department following a fall that occurred due to losing balance while attempting to pick up her medications that had fallen on the floor, resulting in right fibula fracture. She was incidentally found to have severe hypercalcemia with a serum calcium level of 22.8 mg/dL, despite having only mild symptoms such as brain fog and occasional nausea. Laboratory workup revealed acute kidney injury, metabolic alkalosis and a suppressed parathyroid hormone in the setting of excess intake of calcium carbonate tablets for uncontrolled gastroesophageal reflux disease. This, combined with the clinical and laboratory findings, led to a diagnosis of MAS. The patient was treated with aggressive intravenous fluid hydration and calcitonin, which rapidly improved her severe hypercalcemia.
DISCUSSION: MAS is resurfacing as one of the leading causes of hypercalcemia. This resurgence is particularly relevant given the widespread use of calcium-alkali agents for management of osteoporosis, chronic kidney disease, and gastroesophageal reflux disease. The syndrome can present with mild or nonspecific symptoms which makes diagnosis challenging, especially in patients with complex comorbidities. Awareness of MAS is critical for timely identification and treatment.
CONCLUSION: MAS should be considered a key differential diagnosis in patients with hypercalcemia. Early detection and intervention are essential to reverse metabolic disturbances and prevent potentially life-threatening outcomes.