Milk alkali syndrome with acute renal failure requiring hemodialysis treatment

Süt alkali sendromu kronik epigastrik ağrı nedeniyle kalsiyum içeren antiasid kullanan hastalarda tanımlanmıştır. Sendrom kalsiyum içeren antiasidlerin yüksek dozda kullanılması sonrası gelişen hiperkalsemi, metabolik alkaloz ve akut böbrek yetmezliği üçlemesinden oluşmaktadır. Modern ülser tedavilerinin gelişmesiyle sıklığı azalan sendrom günümüzde osteoporozun önlenmesi ve tedavisi amacıyla kalsiyum içeren ilaçların kullanımı nedeniyle artmaya başlamıştır. Süt alkali sendromu hiperkalsemi ve diğer komponentleriyle hayatı tehdit edici olabilir. Çalışmamızda kalsiyum içeren antiasid ilacın aşırı dozda kullanılması sonrası gelişen şiddetli hiperkalsemi ve diyaliz tedavisi gerektiren nonoligürik akut böbrek yetmezliği ile başvuran süt alkali sendromlu bir olguyu rapor ettik.

Hemodiyaliz tedavisi gerektiren akut böbrek yetmezlikli süt alkali sendromu olgusu

Milk alkali syndrome was defined in patients with chronic epigastric pain using calcium containing antacids. The syndrome consists of a triad of hypercalcemia, metabolic alkalosis and acute renal failure following using high doses of calcium containing antacids. The decrease in the frequency of this syndrome with the development of modern ulcer treatment recently started to increase with the consumption of calcium containing medicine for the prevention and treatment of osteoporosis. Milk alkali syndrome may be life threatening because of hypercalcemia and other components. We report here a case with milk alkali syndrome after excessive intake of antacids, presenting with severe hypercalcemia and nonoliguric acute renal failure requiring hemodialysis treatment.

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  • 1) Haspel Y, Dinbar A, Wolfstein I et al. Hypercalcemia and renal insufficiency complicating antacid treatment. Med Chir Dig. 1974; 3(3): 173-7.
  • 2) Jousten E, Guffens P. Milk alkali syndrome caused by ingestion of antacid tablets. Acta Clin Belg. 2008; 63: 103-6.
  • 3) Vanpee D, Delgrange E, Gillet JB et al. J Emerg Med. Ingestion of antacid tablets (Rennie) and acute confusion. 2000 Aug; 19(2): 169-71.
  • 4) Beall DP, Hensiee HB, Webb HR et al. Milk-Alkali syndrome: A historical review and description of the modern version of the syndrome. Am J Med Sci. 2006; 331: 233-42.
  • 5) Picolos MK, Orlander PR. Calcium carbonate toxicity: The updated milk alkali syndrome; report of 3 cases and review of the literature. Endocr Pract. 2005; 11: 272-80.
  • 6) Irtiza Ali A, Waldek S, Lamerton E et al. Milk alkali syndrome associated with excessive ingestion of Rennie: Case report. J Ren Care 2008; 34: 64-67.
  • 7) Abreo K, Adlakha A, Kilpatrick S et al. The milk-alkali syndrome. A reversible form of acute renal failure. Arch Intern Med. 1993 Apr 26; 153(8): 1005-10.
  • 8) Michelle V Gordon, P Shane Hamblin Lawrence P mcmahon. Life-threatening milk-alkali syndrome resulting from antacid ingestion during pregnancy. MJA 2005; 182: 350-351
  • 9) Tuon FF, Nihei CH, Gryschek RC et al. Vitamin D intoxication: A cause of hypocalcaemia and acute renal failure in a HIV patient. Int. J STD AIDS. 2008; 19: 137-8.
  • 10) Georges CG, Guthoff M, Wehrmann M et al. Hypercalcaemic crisis and acute renal failure due to primary hyperparathyroidism. Dtsch Med Wochenschr. 2008; 133: 2639-43
  • 11) Skiqnsberg H, Hartmann A, Fauchald P. Acute renal failure caused by hypercalcaemia. Tidsskr Nor Laegeforen. 2001; 121: 1781-83.
  • 12) Picolos MK, Sims CR, Mastrobattista JM, et al. Milk-alkali syndrome in pregnancy. Obstet Gynecol. 2004; 104: 1201-4.
  • 13) Ackermann D. Hypercalcemia in sarcoidosis--case report, prevalence, pathophysiology and therapeutic options. Ther Umsch. 2007; 64(5): 281-6.
  • 14) Demetriou ET, Pietras SM, Holick MF. Hypercalcemia and soft tissue calcification owing to sarcoidosis: the sunlight-cola connection. J Bone Miner Res. 2010; 25(7): 1695-9.
  • 15) Martínez Mateu JG, Losada González GP, Munar Vila MA, Uriol Rivera M, Gómez Marqués G, Tugores AC. Multiple myeloma, severe hypercalcaemia, acute renal failure and multiple organ failure due to calcinosis. Nefrologia. 2011; 31(2): 233-234.
  • 16) Felsenfeld AJ, Levine BS. Milk alkali syndrome and the dynamics of calcium homeostasis. Clin J Am Soc Nephrol. 2006; 1: 641–654.
  • 17) Orwoll ES. The milk-alkali syndrome: current concepts. Ann Intern Med. 1982; 97(2): 242-8.