Milk-alkali syndrome classification: Difference between revisions
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== Overview == | == Overview == | ||
Milk-alkali syndrome may be classified as the following: acute (toxemic form), subacute (Cope's syndrome) and chronic (Burnett's syndrome). | Milk-alkali syndrome may be classified as the following: acute (toxemic form), subacute (Cope's syndrome), and chronic (Burnett's syndrome). | ||
==Classification== | ==Classification== | ||
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**[[Myalgia]] | **[[Myalgia]] | ||
*[[Metastatic calcification|Metastatic calcifications]] (band keratopathy and [[nephrocalcinosis]]) | *[[Metastatic calcification|Metastatic calcifications]] (band keratopathy and [[nephrocalcinosis]]) | ||
*[[Laboratory]] abnormalities are similar to those in the acute syndrome, but the response to withdrawal of milk and [[alkali]] is quite different. | *[[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. | *[[Myalgia]] and [[Itch|pruritus]] improves slowly as [[calcium]] level slowly normalizes. | ||
*[[Calcium]] levels resolve to normal level, gradually and some abnormal [[calcification]] decrease. | *[[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> | *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> | ||
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
- The acute or toxemic form occurs about one week after treatment with milk and alkali.
- They have symptoms of acute hypercalcemia such as:
- Acute renal insufficiency
- Metabolic alkalosis
- Withdrawal of milk and alkali resolves the symptoms and renal function to normal, rapidly.
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
- Patients have a long history of high milk and alkali consumption.
- They have symptoms of chronic hypercalcemia such as:
- Occasional nausea, vomiting, anorexia and mental changes
- Asthenia
- Polyuria
- Polydipsia
- Pruritus
- Myalgia
- 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 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.[2][3]
References
- ↑ 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.
- ↑ 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.
- ↑ 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.