{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T16:27:06Z","timestamp":1774542426564,"version":"3.50.1"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,2,4]],"date-time":"2022-02-04T00:00:00Z","timestamp":1643932800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Common causes of hypercalcemia include primary hyperparathyroidism and paraneoplastic syndrome of malignancy. Because of this, physicians can easily miss extrinsic causes of hypercalcemia such as milk-alkali syndrome in patients with cancer. We successfully treated a case of acute kidney injury due to severe hypercalcemia caused by milk-alkali syndrome due to long-term milk drinking in a patient with colon cancer.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case Description<\/jats:title><jats:p>A 62-year-old man was referred to nephrology for hypercalcemia and azotemia that was found during preoperative evaluation for colon cancer surgery. The patient had experienced several months of dizziness and anorexia. We started hemodialysis because hypercalcemia and azotemia were not improved despite large amounts of hydration and diuretics. We suspected paraneoplastic syndrome because of concomitant colon cancer and low intact parathyroid hormone (PTH). Renal microcalcifications were observed on ultrasonography. Metastatic calcifications of the lung and stomach were present, but no malignant metastasis appeared on bone scans. There was no evidence of metastatic malignant lesions on chest or abdominal enhanced computed tomography. PTH-related peptide was not detected. Thus, other causes of hypercalcemia beyond malignancy were considered. On history-taking, the patient reported consuming 1,000 to 1,200 mL of milk daily for the prior 3 months. Hypercalcemia was due to chronic milk-alkali syndrome. We advised withdrawal of milk and nutritional pills. Hemodialysis was stopped after 2 weeks since azotemia and hypercalcemia were resolving. Acute kidney injury was improved, and mild hypercalcemia remained when he underwent hemicolectomy after 1 month. Thereafter, serum calcium and creatinine remained normal at discharge and follow-up for 1 year in the outpatient clinic. However, lung calcifications still remained on bone scan after 1 year.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Chronic milk-alkali syndrome is a rare condition resulting from excessive calcium and alkali intake through various routes, like milk, nutritional supplements, and medicines for osteoporosis. Therefore, early management for hypercalcemia should include precise history taking including diet, previous diagnoses, and current medications.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2022.834107","type":"journal-article","created":{"date-parts":[[2022,2,4]],"date-time":"2022-02-04T05:52:57Z","timestamp":1643953977000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Case Report: Acute Kidney Injury Due to Chronic Milk-Alkali Syndrome in a Patient With Colon Cancer"],"prefix":"10.3389","volume":"9","author":[{"given":"Hyo Jin","family":"Lee","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seokho","family":"Yoon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bong-Hoi","family":"Choi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seunghye","family":"Lee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sehyun","family":"Jung","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ha Nee","family":"Jang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Se-Ho","family":"Chang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hyun-Jung","family":"Kim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2022,2,4]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1177\/0885066613507530","article-title":"Hypercalcemia in the intensive care unit: a review of pathophysiology, diagnosis, and modern therapy","author":"Maier","year":"2015","journal-title":"J Intensive Care Med."},{"key":"B2","doi-asserted-by":"publisher","first-page":"S51","DOI":"10.1002\/jbmr.5650061413","article-title":"Differential diagnosis of hypercalcemia","volume":"6","author":"Lafferty","year":"1991","journal-title":"J Bone Miner Res."},{"key":"B3","doi-asserted-by":"publisher","first-page":"261","DOI":"10.4065\/84.3.261","article-title":"Milk-alkali syndrome","volume":"84","author":"Medarov","year":"2009","journal-title":"Mayo Clin Proc."},{"key":"B4","doi-asserted-by":"publisher","first-page":"e398","DOI":"10.7759\/cureus.398","article-title":"Discrepancy between measured serum total carbon dioxide content and bicarbonate concentration calculated from arterial blood gases","volume":"7","author":"Kim","year":"2015","journal-title":"Cureus."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1483","DOI":"10.1007\/s11255-020-02734-1","article-title":"Plasma bicarbonate and total carbon dioxide: terms to be employed with precision","volume":"53","author":"Ing","year":"2021","journal-title":"Int Urol Nephrol."},{"key":"B6","article-title":"Milk-Alkali Syndrome","author":"Ali","year":"2021","journal-title":"In StatPearls, Treasure Island (FL)."},{"key":"B7","doi-asserted-by":"publisher","first-page":"1625","DOI":"10.1001\/jama.1915.02570460001001","article-title":"Gastric and duodenal ulcer","volume":"64","author":"Sippy","year":"1915","journal-title":"JAMA."},{"key":"B8","doi-asserted-by":"publisher","first-page":"641","DOI":"10.2215\/CJN.01451005","article-title":"Milk alkali syndrome and the dynamics of calcium homeostasis","volume":"1","author":"Felsenfeld","year":"2006","journal-title":"Clin J Am Soc Nephrol."},{"key":"B9","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1177\/156482650802900303","article-title":"Worldwide trends in dairy production and consumption and calcium intake: is promoting consumption of dairy products a sustainable solution for inadequate calcium intake?","volume":"29","author":"Wang","year":"2008","journal-title":"Food Nutr Bull."},{"key":"B10","doi-asserted-by":"publisher","first-page":"764","DOI":"10.1002\/jbmr.1790","article-title":"Impact of calcium and vitamin D insufficiencies on serum parathyroid hormone and bone mineral density: analysis of the fourth and fifth Korea National Health and Nutrition Examination Survey (KNHANES IV-3, 2009 and KNHANES V-1, 2010)","volume":"28","author":"Joo","year":"2013","journal-title":"J Bone Miner Res."},{"key":"B11","volume-title":"Is the Calcium Content Really Different Between Regular Milk and Calcium Fortified Milk? 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