Milk-alkali syndrome classification: Difference between revisions

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== Overview ==
Milk-alkali syndrome may be classified as the following: acute (toxemic form), subacute (Cope's syndrome), and chronic (Burnett's syndrome).
==Classification==
==Classification==


Milk- alkali syndrome may be classified as   
In all types of milk-alkali syndrome there are increases in [[calcium]], [[Blood urea nitrogen|BUN]], [[creatinine]], and there are normal or increased [[phosphorus]]. Milk-alkali syndrome may be classified as the following:<ref name="pmid5851468">{{cite journal| author=McMillan DE, Freeman RB| title=The milk alkali syndrome: a study of the acute disorder with comments on the development of the chronic condition. | journal=Medicine (Baltimore) | year= 1965 | volume= 44 | issue= 6 | pages= 485-501 | pmid=5851468 | doi=10.1097/00005792-196511000-00002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5851468  }} </ref>  
 
==== Acute or Toxemic Form ====
*The acute or toxemic form occurs about one week after treatment with milk and [[alkali]].
*They have symptoms of acute hypercalcemia such as:
**[[Headache]], [[dizziness]]
**[[Lethargy]]
**[[Nausea and vomiting|Nausea, vomiting]]
**[[Anorexia]]  
**[[Muscle weakness|Weakness]]
**Mental changes such as  [[psychosis]]
 
* Acute [[renal insufficiency]]
 
*[[Metabolic alkalosis]]
*Withdrawal of milk and [[alkali]] resolves the symptoms and [[renal function]] to normal, rapidly.
 
===== Subacute or Cope's Syndrome =====


==== Acute or toxemic form ====
*Usually seen in patients that have taken milk and [[alkali]] intermittently for years.
*The acute or toxemic form occurred after approximately one week of treatment
*Patients have symptoms of both acute and chronic hypercalcemia and respond to medication withdrawal with gradual improvement. [[Renal function]] improves gradually but significantly.
*The symptoms are  acute hypercalcemia
*Nausea and vomiting
*weakness
*Mental changes with [[psychosis]]
*Depressed [[sensorium]]
*Severe [[metabolic alkalosis]]
*Normal to elevated plasma phosphate concentration
*Acute [[renal insufficiency]]
*Withdrawal of milk and [[alkali]] led to rapid relief of symptoms and the return of normal renal function.


===== Subacute or Cope's syndrome =====
===== Chronic or Burnett's Syndrome =====
*Patients were usually seen during therapy with milk and alkali that had been taken intermittently for years.
*Affected patients had symptoms of both acute and chronic hypercalcemia and responded to medication withdrawal with gradual improvement. Renal function remained mildly impaired in some cases.


===== Chronic  or Burnett's syndrome =====
*Patients have a long history of high milk and [[alkali]] consumption.
*Long history of high milk-alkali intake with symptoms of chronic [[hypercalcemia]] such as  
*They have symptoms of chronic [[hypercalcemia]] such as:
*[[Polyuria]]
**Occasional [[Nausea and vomiting|nausea, vomiting]], [[anorexia]] and mental changes  
*[[polydipsia]]
**[[Asthenia]]  
*Muscle aches, and [[pruritus]]
**[[Polyuria]]
*Evidence of metastatic calcifications, including band [[keratopathy]] and [[nephrocalcinosis]]
**[[Polydipsia]]
*Laboratory abnormalities were similar to those in the acute syndrome, but the response to withdrawal of milk and alkali was quite different
**[[Pruritus]]
*The muscle aches and pruritus improved slowly as the plasma calcium concentration slowly normalized
**[[Myalgia]]
*There is usually minimal or no improvement in renal function, as many patients continued to have chronic renal failure.<ref name="pmid18126919">{{cite journal |vauthors=BURNETT CH, COMMONS RR |title=Hypercalcemia without hypercalcuria or hypophosphatemia, calcinosis and renal insufficiency; a syndrome following prolonged intake of milk and alkali |journal=N. Engl. J. Med. |volume=240 |issue=20 |pages=787–94 |date=May 1949 |pmid=18126919 |doi=10.1056/NEJM194905192402001 |url=}}</ref><ref name="pmid16268810">{{cite journal |vauthors=Picolos MK, Lavis VR, Orlander PR |title=Milk-alkali syndrome is a major cause of hypercalcaemia among non-end-stage renal disease (non-ESRD) inpatients |journal=Clin. Endocrinol. (Oxf) |volume=63 |issue=5 |pages=566–76 |date=November 2005 |pmid=16268810 |doi=10.1111/j.1365-2265.2005.02383.x |url=}}</ref>
*[[Metastatic calcification|Metastatic calcifications]] (band keratopathy and [[nephrocalcinosis]])
*[[Laboratory]] abnormalities are similar to those in the acute syndrome, but the response to the withdrawal of milk and [[alkali]] is quite different.
*[[Myalgia]] and [[Itch|pruritus]] improves slowly as [[calcium]] level slowly normalizes.
*[[Calcium]] levels resolve to a normal level, gradually and some abnormal [[calcification]] decrease.
*There is usually minimal or no improvement in [[renal function]], as many patients continue to have [[chronic renal failure]].<ref name="pmid18126919">{{cite journal |vauthors=BURNETT CH, COMMONS RR |title=Hypercalcemia without hypercalcuria or hypophosphatemia, calcinosis and renal insufficiency; a syndrome following prolonged intake of milk and alkali |journal=N. Engl. J. Med. |volume=240 |issue=20 |pages=787–94 |date=May 1949 |pmid=18126919 |doi=10.1056/NEJM194905192402001 |url=}}</ref><ref name="pmid16268810">{{cite journal |vauthors=Picolos MK, Lavis VR, Orlander PR |title=Milk-alkali syndrome is a major cause of hypercalcaemia among non-end-stage renal disease (non-ESRD) inpatients |journal=Clin. Endocrinol. (Oxf) |volume=63 |issue=5 |pages=566–76 |date=November 2005 |pmid=16268810 |doi=10.1111/j.1365-2265.2005.02383.x |url=}}</ref>


<nowiki>==References==</nowiki>
==References==
{{reflist|2}}
{{reflist|2}}
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Latest revision as of 13:02, 16 July 2020


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shakiba Hassanzadeh, MD[2]

Overview

Milk-alkali syndrome may be classified as the following: acute (toxemic form), subacute (Cope's syndrome), and chronic (Burnett's syndrome).

Classification

In all types of milk-alkali syndrome there are increases in calcium, BUN, creatinine, and there are normal or increased phosphorus. Milk-alkali syndrome may be classified as the following:[1]

Acute or Toxemic Form

Subacute or Cope's Syndrome
  • Usually seen in patients that have taken milk and alkali intermittently for years.
  • Patients have symptoms of both acute and chronic hypercalcemia and respond to medication withdrawal with gradual improvement. Renal function improves gradually but significantly.
Chronic or Burnett's Syndrome

References

  1. ↑ McMillan DE, Freeman RB (1965). "The milk alkali syndrome: a study of the acute disorder with comments on the development of the chronic condition". Medicine (Baltimore). 44 (6): 485–501. doi:10.1097/00005792-196511000-00002. PMID 5851468.
  2. ↑ BURNETT CH, COMMONS RR (May 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. doi:10.1056/NEJM194905192402001. PMID 18126919.
  3. ↑ Picolos MK, Lavis VR, Orlander PR (November 2005). "Milk-alkali syndrome is a major cause of hypercalcaemia among non-end-stage renal disease (non-ESRD) inpatients". Clin. Endocrinol. (Oxf). 63 (5): 566–76. doi:10.1111/j.1365-2265.2005.02383.x. PMID 16268810.

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