# A Case Report of Milk-Alkali Syndrome Secondary to Excessive Antacid Use

## TL;DR

A 60-year-old man developed milk-alkali syndrome from excessive antacid use, leading to severe hypercalcemia and kidney injury, which was successfully treated.

## Contribution

This case highlights the resurgence of milk-alkali syndrome due to over-the-counter calcium use and emphasizes early recognition in emergency settings.

## Key findings

- Excessive antacid use can cause severe hypercalcemia and acute kidney injury.
- Prompt treatment with intravenous fluids and calcitonin resolved symptoms within 48 hours.
- Milk-alkali syndrome is a treatable but potentially serious condition that emergency physicians should be aware of.

## Abstract

Milk-alkali syndrome is characterized by the triad of hypercalcemia, metabolic alkalosis, and acute kidney injury resulting from excessive intake of calcium and absorbable alkali. Despite falling out of prominence with the advent of modern ulcer treatments, milk-alkali syndrome has experienced a resurgence with the widespread availability of over-the-counter calcium preparations, which now account for up to 10% of hypercalcemia cases.

A 60-year-old man with multiple comorbidities presented to the emergency department with altered mental status after his scheduled kyphoplasty was canceled due to concerning neurological findings. Laboratory evaluation revealed severe hypercalcemia, marked metabolic alkalosis, and acute kidney injury. Further history revealed excessive antacid consumption for heartburn. The patient was diagnosed with milk-alkali syndrome, treated with intravenous fluids and calcitonin, and discharged home after 48 hours with complete resolution of signs and symptoms.

Milk-alkali syndrome represents an increasingly recognized cause of severe hypercalcemia in the emergency setting. This case demonstrates the importance of thorough medication history, early recognition of the classic triad, and prompt initiation of conservative management. With the growing use of calcium-based, over-the-counter preparations, emergency physicians must maintain vigilance for this potentially serious but readily treatable condition.