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Milk-alkali syndrome
     
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Milk-alkali syndrome

Calcium-alkali syndrome; Cope syndrome; Burnett syndrome; Hypercalcemia; Calcium metabolism disorder

 

Milk-alkali syndrome is a condition in which there is a high level of calcium in the body (hypercalcemia). This causes a shift in the body's acid/base balance toward alkaline (metabolic alkalosis). As a result, there can be a loss of kidney function.

Causes

 

Milk-alkali syndrome is almost always caused by taking too many calcium supplements, usually in the form of calcium carbonate. Calcium carbonate is a common calcium supplement. It is often taken to prevent or treat bone loss (osteoporosis). Calcium carbonate is also an ingredient found in many antacids (such as Tums).

A high level of vitamin D in the body, such as from taking supplements, can worsen milk-alkali syndrome.

Calcium deposits in the kidneys and in other tissues can occur in milk-alkali syndrome.

 

Symptoms

 

In the beginning, the condition usually has no symptoms (asymptomatic). When symptoms do occur, they can include:

  • Back, middle of the body, and low back pain in the kidney area (related to kidney stones)
  • Confusion, strange behavior
  • Constipation
  • Depression
  • Excessive urination
  • Fatigue
  • Irregular heartbeat (arrhythmia)
  • Nausea or vomiting
  • Other symptoms that can result from kidney failure

 

Exams and Tests

 

Calcium deposits within the tissue of the kidney (nephrocalcinosis) may be seen on:

  • X-rays
  • CT scan
  • Ultrasound

Other tests used to make a diagnosis may include:

  • Electrolyte levels to check the mineral levels in the body
  • Electrocardiogram (ECG) to check the electrical activity of the heart
  • Electroencephalogram (EEG) to measure the electrical activity of the brain
  • Glomerular filtration rate (GFR) to check how well the kidneys are working
  • Blood calcium and vitamin D levels

 

Treatment

 

In severe cases, treatment involves giving fluids through the vein (by IV). Otherwise, treatment involves drinking fluids along with reducing or stopping calcium supplements and antacids that contain calcium. Vitamin D supplements also need to be reduced or stopped.

 

Outlook (Prognosis)

 

This condition is often reversible if kidney function remains normal. Severe prolonged cases may lead to permanent kidney failure requiring dialysis.

 

Possible Complications

 

The most common complications include:

  • Calcium deposits in tissues (calcinosis)
  • Kidney failure
  • Kidney stones

 

When to Contact a Medical Professional

 

Contact your health care provider if:

  • You take a lot of calcium supplements or you often use antacids that contain calcium, such as Tums. You may need to be checked for milk-alkali syndrome.
  • You have any symptoms that might suggest kidney problems.

 

Prevention

 

If you use calcium-containing antacids often, tell your provider about digestive problems. If you are trying to prevent osteoporosis, do not take more than 1.2 grams (1200 milligrams) of calcium per day unless instructed by your provider.

 

 

Open References

References

Bilezikian JP, Walker MD, Binkley N, Goltzman D, Mannstadt M. Hormones and disorders of mineral metabolism. In: Melmed S, Auchus RJ, Goldfine AB, Rosen CJ, Kopp PA, eds. Williams Textbook of Endocrinology. 15th ed. Philadelphia, PA: Elsevier; 2025:chap 27.

Seifter JL. Acid-base disorders. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 104.

Thakker RV. The parathyroid glands, hypercalcemia, and hypocalcemia. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 227.

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                Review Date: 10/23/2025

                Reviewed By: Walead Latif, MD, Nephrologist and Clinical Associate Professor, Rutgers Medical School, Newark, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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