{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T14:17:38Z","timestamp":1784557058617,"version":"3.55.0"},"reference-count":16,"publisher":"Bioscientifica","license":[{"start":{"date-parts":[[2018,10,31]],"date-time":"2018-10-31T00:00:00Z","timestamp":1540944000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/3.0\/deed.en_GB"}],"content-domain":{"domain":["edm.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2018,10,31]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>A 74-year-old woman presented with progressive lethargy, confusion, poor appetite and abdominal pain. She was found to have non-PTH-mediated severe hypercalcemia with renal failure and metabolic alkalosis. Extensive workup for hypercalcemia to rule out alternate etiology was unrevealing. Upon further questioning, she was taking excess calcium carbonate (Tums) for her worsening heartburn. She was diagnosed with milk-alkali syndrome (MAS). Her hypercalcemia and alkalosis recovered completely with aggressive hydration along with improvement in her renal function. High index of suspicion should be maintained and history of drug and supplements, especially calcium ingestion, should be routinely asked in patients presenting with hypercalcemia to timely diagnose MAS and prevent unnecessary tests and treatments.<\/jats:p>\n                  <jats:sec>\n                    <jats:title>Learning points:<\/jats:title>\n                    <jats:list list-type=\"bullet\">\n                      <jats:list-item>\n                        <jats:p>Suspect milk-alkali syndrome in patients with hypercalcemia, metabolic alkalosis and renal failure, especially in context of ingestion of excess calcium-containing supplements.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Careful history of over-the-counter medications, supplements and diet is crucial to diagnose milk-alkali syndrome.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Milk-alkali syndrome may cause severe hypercalcemia in up to 25\u201330% of cases.<\/jats:p>\n                      <\/jats:list-item>\n                    <\/jats:list>\n                  <\/jats:sec>","DOI":"10.1530\/edm-18-0075","type":"journal-article","created":{"date-parts":[[2018,11,8]],"date-time":"2018-11-08T07:04:47Z","timestamp":1541660687000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-2","source":"Crossref","is-referenced-by-count":1,"title":["Acute milk-alkali syndrome"],"prefix":"10.1530","volume":"2018","author":[{"given":"Bidhya","family":"Timilsina","sequence":"first","affiliation":[{"name":"1Department of Internal Medicine, Diabetes and Metabolism, Department of Medicine, Reading Hospital, Reading, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niranjan","family":"Tachamo","sequence":"additional","affiliation":[{"name":"1Department of Internal Medicine, Diabetes and Metabolism, Department of Medicine, Reading Hospital, Reading, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prem Raj","family":"Parajuli","sequence":"additional","affiliation":[{"name":"1Department of Internal Medicine, Diabetes and Metabolism, Department of Medicine, Reading Hospital, Reading, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilan","family":"Gabriely","sequence":"additional","affiliation":[{"name":"2Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, Reading Hospital, Reading, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","reference":[{"key":"ref151","first-page":"1","article-title":"YangJDLawsonPBelandS hypercalcemia from the milk - alkali syndrome of https org","author":"Severe","journal-title":"American Journal Medicine"},{"key":"ref51","doi-asserted-by":"crossref","first-page":"1952","DOI":"10.1056\/NEJMcps0706188","article-title":"Clinical problem-solving. 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