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Antacid-induced acute hypercalcemia- A Case Report
Emanuela Cimpeanu and colleagues from the Department of Internal Medicine, Richmond University Medical Center, Staten Island, NY, USA recently reported an interesting case of hypercalcemia which resulted after acute oral intake of a moderate amount of antacids (calcium tablets) and normalized after supplement withdrawal.
The case study is published in the SAGE Journals.
Hypercalcemia is frequently encountered in both hospital wards and the primary care setting; 90% of cases can be attributed to primary hyperparathyroidism and malignancy. However, a minority are caused by medications, of which calcium supplements have been an increasingly common etiology.
Nowadays, increasing numbers of patients are using calcium carbonate not only as an antacid but also as calcium supplementation, especially when postmenopausal, on corticosteroid therapy or in renal failure. Calcium carbonate, which is alkaline, is a major source of calcium and alkali. This has led to the reemergence of the so-called "milk-alkali syndrome" aka "calcium-alkali syndrome," characterized by hypercalcemia, metabolic alkalosis, and renal failure.
The researchers studied a 61-year-old male who presented with a past medical history of type 2 diabetes mellitus (T2DM), hypertension, and hyperlipidemia ad visited for a regular follow-up. Routine examinations yielded no alterations. However, patient underwent laboratory testing the day prior to being seen. Results were significant for calcium 11.1 mg/dL, albumin 4.7 g/dL, blood urea nitrogen (BUN) 21 mg/dL, creatinine 0.91 mg/dL, chloride 101 mmol/L, and fasting glucose 139mg/dL.
Careful history revealed that, the evening prior the blood draw, the patient experienced an unusual episode of sudden-onset epigastric burning and took six chewable tables of Tums 200 mg calcium (500 mg).Given the mild elevation in calcium and the lack of palpitations or tachycardia, an electrocardiography was not ordered. Five days later, he went for repeat blood work. By this time, calcium normalized to 9.3 mg/dL, thus ruling out hyperparathyroidism. Ionized calcium and parathyroid hormone intact were 4.8 mg/dL and 54 pg/mL, respectively.
Therefore, the authors discussed that antacid-induced hypercalcemia should be a differential diagnosis when a patient presents with elevated calcium levels. A careful medication history, including over-the-counter supplements, should be taken.
Timely medication withdrawal and increased hydration can minimize progression to calcium–alkali syndrome and decrease the need for the more expensive investigations required in the workup of malignancy and hyperparathyroidism.
Hence, the authors concluded that "clinicians must keep a high index of suspicion in any patient who presents with asymptomatic hypercalcemia and perform thorough reconciliation of all medications, including those available over-the-counter. Although antacids are considered safe, hypercalcemia can occur. Physicians should educate patients on the risks associated with antacid ingestion."
BDS, MDS( Pedodontics and Preventive Dentistry)
Dr. Nandita Mohan is a practicing pediatric dentist with more than 5 years of clinical work experience. Along with this, she is equally interested in keeping herself up to date about the latest developments in the field of medicine and dentistry which is the driving force for her to be in association with Medical Dialogues. She also has her name attached with many publications; both national and international. She has pursued her BDS from Rajiv Gandhi University of Health Sciences, Bangalore and later went to enter her dream specialty (MDS) in the Department of Pedodontics and Preventive Dentistry from Pt. B.D. Sharma University of Health Sciences. Through all the years of experience, her core interest in learning something new has never stopped. She can be contacted at editorial@medicaldialogues.in. Contact no. 011-43720751
Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751