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1998 Presentations for the Poster and Vignette Sessions
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MILD ALKALI SYNDROME: A NEW RESURGENCE. Deborah Hower, MD, James Cerletty, MD. Medical College of Wisconsin, Milwaukee, WI

Introduction: Mile Alkali Syndrome (MAS) consists of the triad of hypercalcemia, metabolic alkalosis and renal insufficiency. It was first reported in 1923 with the introduction of the Sippy ulcer regimen and is a rare entity with modern ulcer therapy. However, with the use of calcium carbonate as a antacid or for osteoporosis prevention, the syndrome is being more frequently encountered.

Case Report: A 51­year­old Caucasian male was hospitalized after prolonged use of calcium carbonate for dyspepsia. He complained of confusion, weakness, nausea, vomiting and myalgias. Physical exam was significant for hypertension, confusion, generalized weakness and dry mucous membranes. Laboratory analysis revealed hypercalcemia (17.5 mg/dl), and elevated bicarbonate (29mmol/L), and an elevated creatinine (2.9mg/dl). The patient was treated with intravenous hydration, furosemide diuresis and cessation of the calcium carbonate. The patient had complete resolution of his symptoms and normalization of his creatinine, calcium and bicarbonate.

Discussion: The diagnosis of MAS requires a careful history. It has been reported that 2 to 8 grams of elemental calcium, ingested with bicarbonate, has been associated with the syndrome. There are three forms of MAS: Acute, Intermediate and Chronic ranging from reversible to irreversible. If MAS is diagnosed early in its course the manifestations are reversible with conservative treatment. Thus, MAS can cause life threatening hypercalcemia and renal failure that is treatable and reversible if diagnosed early in the course of the syndrome.

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