Milk-alkali syndrome: Difference between revisions

Jump to navigation Jump to search
No edit summary
No edit summary
Line 13: Line 13:
   MeshID        = |
   MeshID        = |
}}
}}
In [[medicine]], '''milk-alkali syndrome''', also called Burnett's syndrome in honour of the American physician who first described it, is characterized by [[hypercalcemia]] caused by repeated ingestion of [[calcium]] and absorbable [[alkali]] (such as [[calcium carbonate]], or [[milk]] and [[sodium bicarbonate]]).  If untreated, '''milk-alkali syndrome''' may lead to [[metastatic calcification]] and [[renal failure]].   
{{SI}}
{{CMG}}
 
{{Editor Help}}
 
'''Milk-alkali syndrome''', also called Burnett's syndrome in honour of the American physician who first described it, is characterized by [[hypercalcemia]] caused by repeated ingestion of [[calcium]] and absorbable [[alkali]] (such as [[calcium carbonate]], or [[milk]] and [[sodium bicarbonate]]).  If untreated, '''milk-alkali syndrome''' may lead to [[metastatic calcification]] and [[renal failure]].   


It was most common in the early 20th century, but there has been a recent increase in the number of cases reported.<ref name="pmid17483976">{{cite journal |author=Caruso JB, Patel RM, Julka K, Parish DC |title=Health-behavior induced disease: return of the milk-alkali syndrome |journal=J Gen Intern Med |volume=22 |issue=7 |pages=1053–5 |year=2007 |month=July |pmid=17483976 |doi=10.1007/s11606-007-0226-0 |url=http://dx.doi.org/10.1007/s11606-007-0226-0}}</ref><ref name="pmid16702792">{{cite journal |author=Beall DP, Henslee HB, Webb HR, Scofield RH |title=Milk-alkali syndrome: a historical review and description of the modern version of the syndrome |journal=Am. J. Med. Sci. |volume=331 |issue=5 |pages=233–42 |year=2006 |month=May |pmid=16702792 |doi= |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?an=00000441-200605000-00001}}</ref>
It was most common in the early 20th century, but there has been a recent increase in the number of cases reported.<ref name="pmid17483976">{{cite journal |author=Caruso JB, Patel RM, Julka K, Parish DC |title=Health-behavior induced disease: return of the milk-alkali syndrome |journal=J Gen Intern Med |volume=22 |issue=7 |pages=1053–5 |year=2007 |month=July |pmid=17483976 |doi=10.1007/s11606-007-0226-0 |url=http://dx.doi.org/10.1007/s11606-007-0226-0}}</ref><ref name="pmid16702792">{{cite journal |author=Beall DP, Henslee HB, Webb HR, Scofield RH |title=Milk-alkali syndrome: a historical review and description of the modern version of the syndrome |journal=Am. J. Med. Sci. |volume=331 |issue=5 |pages=233–42 |year=2006 |month=May |pmid=16702792 |doi= |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?an=00000441-200605000-00001}}</ref>

Revision as of 19:56, 9 January 2009

Milk-alkali syndrome
ICD-9 275.42
DiseasesDB 8215
MedlinePlus 000332
eMedicine med/1477 

WikiDoc Resources for Milk-alkali syndrome

Articles

Most recent articles on Milk-alkali syndrome

Most cited articles on Milk-alkali syndrome

Review articles on Milk-alkali syndrome

Articles on Milk-alkali syndrome in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Milk-alkali syndrome

Images of Milk-alkali syndrome

Photos of Milk-alkali syndrome

Podcasts & MP3s on Milk-alkali syndrome

Videos on Milk-alkali syndrome

Evidence Based Medicine

Cochrane Collaboration on Milk-alkali syndrome

Bandolier on Milk-alkali syndrome

TRIP on Milk-alkali syndrome

Clinical Trials

Ongoing Trials on Milk-alkali syndrome at Clinical Trials.gov

Trial results on Milk-alkali syndrome

Clinical Trials on Milk-alkali syndrome at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Milk-alkali syndrome

NICE Guidance on Milk-alkali syndrome

NHS PRODIGY Guidance

FDA on Milk-alkali syndrome

CDC on Milk-alkali syndrome

Books

Books on Milk-alkali syndrome

News

Milk-alkali syndrome in the news

Be alerted to news on Milk-alkali syndrome

News trends on Milk-alkali syndrome

Commentary

Blogs on Milk-alkali syndrome

Definitions

Definitions of Milk-alkali syndrome

Patient Resources / Community

Patient resources on Milk-alkali syndrome

Discussion groups on Milk-alkali syndrome

Patient Handouts on Milk-alkali syndrome

Directions to Hospitals Treating Milk-alkali syndrome

Risk calculators and risk factors for Milk-alkali syndrome

Healthcare Provider Resources

Symptoms of Milk-alkali syndrome

Causes & Risk Factors for Milk-alkali syndrome

Diagnostic studies for Milk-alkali syndrome

Treatment of Milk-alkali syndrome

Continuing Medical Education (CME)

CME Programs on Milk-alkali syndrome

International

Milk-alkali syndrome en Espanol

Milk-alkali syndrome en Francais

Business

Milk-alkali syndrome in the Marketplace

Patents on Milk-alkali syndrome

Experimental / Informatics

List of terms related to Milk-alkali syndrome

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Please Take Over This Page and Apply to be Editor-In-Chief for this topic: There can be one or more than one Editor-In-Chief. You may also apply to be an Associate Editor-In-Chief of one of the subtopics below. Please mail us [2] to indicate your interest in serving either as an Editor-In-Chief of the entire topic or as an Associate Editor-In-Chief for a subtopic. Please be sure to attach your CV and or biographical sketch.

Milk-alkali syndrome, also called Burnett's syndrome in honour of the American physician who first described it, is characterized by hypercalcemia caused by repeated ingestion of calcium and absorbable alkali (such as calcium carbonate, or milk and sodium bicarbonate). If untreated, milk-alkali syndrome may lead to metastatic calcification and renal failure.

It was most common in the early 20th century, but there has been a recent increase in the number of cases reported.[1][2]

Pathophysiology

The name "milk-alkali syndrome" derives from when patients would take in excessive amounts of milk and antacids to control their dyspepsia, leading to overingestion of two key ingredients that lead to the disorder, excess calcium and excess base. Ingesting over two grams of elemental calcium per day produces this disorder in susceptible individuals. Gastrointestinal absorption of such a large amount of calcium leads to hypercalcemia. This inhibits parathyroid hormone secretion by the parathyroid gland and may also lead to diabetes insipidus. The body's attempt to rid itself of the excess base in the urine may cause bicarbonaturia and subsequent hypovolemia due to transport of sodium ions to accompany the bicarbonate.

Hypovolemia may increase the reabsorption of calcium and bicarbonate in the proximal convoluted tubules of the kidney. Elevated bicarbonate levels in the blood raises the pH, producing an alkalemia. In this state, excess bicarbonate eventually begins to reach the distal convoluted tubule, leading to sodium retention in the lumen, an effect similar to the action of thiazide diuretics, hence increasing lumen positivity and driving calcium through the passive calcium channels to bind intracellular calbindin. Finally, because of the decreased intracellular sodium, there is an increased driving force for the basolateral Na+/Ca++ antiporter, thus facilitating calcium reabsorption. Basically, hypovolemia is the culprit that prevents correction of the hypercalcemia.

The understanding of this mechanism led to the development of a simple yet elegant treatment for hypercalcemia. The first and most important step is intravenous infusion of normal saline to restore the intravascular volume, which reverses the calcium and bicarbonate retention in the PCT. Then a loop diuretic is used, but only after the volume replacement is complete, otherwise volume contraction would result, which would further exacerbate the hypercalcemia. The loop diuretics inhibit the Na-K-2Cl symporter and hence eliminate passive diffusion of potassium into the lumen via the ROMK channel. This effectively removes the net positive charge from the lumen, one of the main driving forces for calcium reabsorption via the paracellular pathway. In addition, loop diuretics increase the flow of luminal contents, which helps flush the calcium to the distal nephron.

Clinical

Effects due to hypercalcemia may be remembered by bones, stones, groans and psychiatric overtones. This means an increased risk of kidney stones, bone fractures, anorexia, vomiting, constipation and a host of psychiatric effects, including weakness, fatigue and altered mental status. Thus, a level of serum calcium must be obtained, but a full workup must include total/ionized calcium, albumin, phosphate, PTH, PTHrP, vitamin D and TSH. In addition, evaluation of hypercalcemia must include an ECG, which may show a short QT interval.

Eponym

It is named for Charles Hoyt Burnett.[3][4]

References

  1. Caruso JB, Patel RM, Julka K, Parish DC (2007). "Health-behavior induced disease: return of the milk-alkali syndrome". J Gen Intern Med. 22 (7): 1053–5. doi:10.1007/s11606-007-0226-0. PMID 17483976. Unknown parameter |month= ignored (help)
  2. Beall DP, Henslee HB, Webb HR, Scofield RH (2006). "Milk-alkali syndrome: a historical review and description of the modern version of the syndrome". Am. J. Med. Sci. 331 (5): 233–42. PMID 16702792. Unknown parameter |month= ignored (help)
  3. Template:WhoNamedIt
  4. Burnett CH, Commons RR, Albright F, Howard JE (1949). "Hypercalcemia without hypercalcuria or hypophosphatemia, calcinosis and renal insufficiency; a syndrome following prolonged intake of milk and alkali". N. Engl. J. Med. 240 (20): 787–94. PMID 18126919.

External links

  • eMedicine.com - Milk-Alkali Syndrome ([3])

Template:Mineral metabolic pathology Template:SIB


de:Burnett-Syndrom


Template:WikiDoc Sources