Friday, October 1, 2010

CLINICAL CASE 26 , ANSWER and SUMMARY

Which Statement regarding " Milk Alkali Syndrome" is False?
The "true" Milk Alkali syndrome incidence declined in the 1980s due to the advent of H2 blockers
  0 (0%)
Currently, the cases of this entity are more accurately termed Calcium Alkali syndrome
  1 (5%)
 
It is NOT a common cause of hospital admissions for hypercalcemia
  5 (29%)
 
It classically presents with hypercalcemia, hypophosphatemia, metabolic alkalosis and acute renal injury
  4 (23%)
 
Levels of 1,25 hydroxy vitamin D are usually low in majority of these cases, but not all.
  2 (11%)
 
It affects post menopausal women and pregnant women the most
  5 (29%)
 



Lets take it one by one.  In the early 1900s, due to excessive milk intake and Sippy method - there were many cases of Milk Alkali syndrome. It did decline in 1980s due to the advent of H2 Blockers and also the decrease intake of Milk in general.  There are now cases started in 1990s in large part seen in post menopausal women due to increase intake of Calcium and Vitamin D medications and the new term for this entity might be " Calcium Alkali syndrome".  It is the 3rd most common cause of hospital admissions for hypercalcemia in the US, following hyperparathyrodisim and malignancy induced hypercalcemia.
It classically presents with Increased ca, low phos and met alk and acute kidney injury.  "Tums" might be most common culprit.  The earlier cases of "Milk-Alkali" syndrome usually presented with hypercalcemia and hyperphosphatemia due to MILK ingestion.  Levels of 1,25 Vitamin D in patients with this syndrome are usually low due to suppression but there can be few cases of normal to inappropriately high as well( due to possible prior exposure to Vitamin D supplements).

In summary, its a disorder that we have to keep in our differential if the incidence is too high. The correct answer hence is 3 as it is a common cause of hospital admissions, perhaps not diagnosed right away!

take a look at a recent JASN reference
http://www.ncbi.nlm.nih.gov/pubmed/20413609

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