Bondje et al. report a case with useful learning points for both endocrinology and general medicine teams. A 72-year-old woman presented with a short history of acute confusion, abdominal pain and constipation. Her past medical history included osteoporosis and chronic kidney disease. She was found to have significant hypercalcaemia (adjusted calcium 3.77mmol/l) on admission, a low parathyroid hormone level and metabolic alkalosis. Treatment included intravenous fluids and bisphosphonate. Extensive investigation for the cause of hypercalcaemia (imaging, myeloma screening, vasculitis screening, serum angiotensin-converting enzyme, bone marrow biopsy) did not find a culprit pathology.

When the patient’s confusion resolved, she reported having taken over-the-counter antacid medication in the weeks preceding her admission. This had been taken alongside her prescribed calcium carbonate/cholecalciferol tablets. The maximum recommended dose of the antacid medication contains an amount of elemental calcium in excess of the recommended daily allowance for older adults.

The authors suggest that education of patients and healthcare professionals, in addition to better warning information on over-the-counter preparations, would help reduce instances of excessive calcium ingestion and subsequent milk-alkali syndrome, particularly in older patients who have additional risk factors.

Read the full article in Endocrinology, Diabetes & Metabolism Case Reports doi: 10.1530/EDM-21-0151