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A Case of Milk-Alkali Syndrome Caused by Diuretic-Induced Alkalosis and Polypharmacy
Milk-alkali syndrome, which is characterized by hypercalcemia, metabolic alkalosis, and renal dysfunction, typically results from the ingestion of large amounts of calcium and absorbable alkaline products. However, these symptoms can also manifest when alkalosis and calcium loading occur simultaneou...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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MDPI
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10385108/ https://www.ncbi.nlm.nih.gov/pubmed/37512156 http://dx.doi.org/10.3390/medicina59071345 |
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author | Mizutani, Naoya Goda, Ken Kenzaka, Tsuneaki |
author_facet | Mizutani, Naoya Goda, Ken Kenzaka, Tsuneaki |
author_sort | Mizutani, Naoya |
collection | PubMed |
description | Milk-alkali syndrome, which is characterized by hypercalcemia, metabolic alkalosis, and renal dysfunction, typically results from the ingestion of large amounts of calcium and absorbable alkaline products. However, these symptoms can also manifest when alkalosis and calcium loading occur simultaneously, owing to other factors. We report a case of milk-alkali syndrome caused by loop-diuretic-induced alkaline load and polypharmacy in an 85-year-old Japanese woman with multiple comorbidities, including osteoporosis, hypertension, type 2 diabetes, dyslipidemia, and Parkinson’s disease. The patient regularly took 14 drugs, including calcium L-aspartate, eldecalcitol, celecoxib, and a fixed-dose combination of losartan and hydrochlorothiazide. Immediately before admission, furosemide was administered for the treatment of edema. The patient presented with chest discomfort, general malaise, and clinical signs of dehydration, hypercalcemia, hypophosphatemia, hypokalemia, and hypomagnesemia, accompanied by electrocardiogram abnormalities, renal dysfunction, and chloride-resistant metabolic alkalosis. The hypercalcemia was specifically induced by calcium L-aspartate and eldecalcitol. The hypomagnesaemia and hypophosphatemia were caused by diuretics and hypercalcemia. Thus, all the oral medications were discontinued, and rehydration and electrolyte correction therapy were administered. The final diagnosis was milk-alkali syndrome caused by the concomitant use of loop diuretics and other medications, without absorbable alkaline preparation use. This case underscores the importance of considering drug-related factors, checking concomitant medications, and being aware of the benefits, harmful effects, and side effects of polypharmacy in older adults with multimorbidity. |
format | Online Article Text |
id | pubmed-10385108 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-103851082023-07-30 A Case of Milk-Alkali Syndrome Caused by Diuretic-Induced Alkalosis and Polypharmacy Mizutani, Naoya Goda, Ken Kenzaka, Tsuneaki Medicina (Kaunas) Case Report Milk-alkali syndrome, which is characterized by hypercalcemia, metabolic alkalosis, and renal dysfunction, typically results from the ingestion of large amounts of calcium and absorbable alkaline products. However, these symptoms can also manifest when alkalosis and calcium loading occur simultaneously, owing to other factors. We report a case of milk-alkali syndrome caused by loop-diuretic-induced alkaline load and polypharmacy in an 85-year-old Japanese woman with multiple comorbidities, including osteoporosis, hypertension, type 2 diabetes, dyslipidemia, and Parkinson’s disease. The patient regularly took 14 drugs, including calcium L-aspartate, eldecalcitol, celecoxib, and a fixed-dose combination of losartan and hydrochlorothiazide. Immediately before admission, furosemide was administered for the treatment of edema. The patient presented with chest discomfort, general malaise, and clinical signs of dehydration, hypercalcemia, hypophosphatemia, hypokalemia, and hypomagnesemia, accompanied by electrocardiogram abnormalities, renal dysfunction, and chloride-resistant metabolic alkalosis. The hypercalcemia was specifically induced by calcium L-aspartate and eldecalcitol. The hypomagnesaemia and hypophosphatemia were caused by diuretics and hypercalcemia. Thus, all the oral medications were discontinued, and rehydration and electrolyte correction therapy were administered. The final diagnosis was milk-alkali syndrome caused by the concomitant use of loop diuretics and other medications, without absorbable alkaline preparation use. This case underscores the importance of considering drug-related factors, checking concomitant medications, and being aware of the benefits, harmful effects, and side effects of polypharmacy in older adults with multimorbidity. MDPI 2023-07-22 /pmc/articles/PMC10385108/ /pubmed/37512156 http://dx.doi.org/10.3390/medicina59071345 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Case Report Mizutani, Naoya Goda, Ken Kenzaka, Tsuneaki A Case of Milk-Alkali Syndrome Caused by Diuretic-Induced Alkalosis and Polypharmacy |
title | A Case of Milk-Alkali Syndrome Caused by Diuretic-Induced Alkalosis and Polypharmacy |
title_full | A Case of Milk-Alkali Syndrome Caused by Diuretic-Induced Alkalosis and Polypharmacy |
title_fullStr | A Case of Milk-Alkali Syndrome Caused by Diuretic-Induced Alkalosis and Polypharmacy |
title_full_unstemmed | A Case of Milk-Alkali Syndrome Caused by Diuretic-Induced Alkalosis and Polypharmacy |
title_short | A Case of Milk-Alkali Syndrome Caused by Diuretic-Induced Alkalosis and Polypharmacy |
title_sort | case of milk-alkali syndrome caused by diuretic-induced alkalosis and polypharmacy |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10385108/ https://www.ncbi.nlm.nih.gov/pubmed/37512156 http://dx.doi.org/10.3390/medicina59071345 |
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