SynopsisCodesLook ForDiagnostic PearlsDifferential Diagnosis & PitfallsBest TestsManagement PearlsTherapyDrug Reaction DataReferences
Milk-alkali syndrome
Other Resources UpToDate PubMed

Milk-alkali syndrome

Contributors: Casey Silver MD, Catherine Moore MD, Abhijeet Waghray MD
Other Resources UpToDate PubMed


Milk-alkali syndrome is a rare cause of hypercalcemia resulting from overconsumption of calcium and absorbable alkali. Patients present with the triad of hypercalcemia, renal impairment, and metabolic alkalosis. In the past 20 years, hospitals have seen an increase in cases induced by calcium carbonate therapy. Most patients are women with osteoporosis. Other risk factors include advanced age, certain medications (thiazide diuretics, angiotensin-converting enzyme [ACE] inhibitors, angiotensin receptor blockers, and NSAIDs), chronic renal disease, dialysis, pregnancy, and betel nut chewing. Overconsumption may be due to a cumulative effect.

Many patients are asymptomatic, or they may present with findings related to hypercalcemia, including nausea, weakness, pruritus, anorexia, fatigue, headache, mental status alteration, myalgia, and insomnia. Laboratory test results may reveal hypophosphatemia and hypomagnesemia.

Therapy is the removal of the source of extra calcium and treatment with non-thiazide diuretics and isotonic saline.


E83.52 – Hypercalcemia

43258006 – Milk alkali syndrome

Look For

Subscription Required

Diagnostic Pearls

Subscription Required

Differential Diagnosis & Pitfalls

Other conditions that may cause hypercalcemia include:
  • Hyperthyroidism
  • Primary hyperparathyroidism or tertiary hyperparathyroidism
  • Ectopic secretion of parathyroid hormone-related peptide by Renal cell carcinoma or Cutaneous squamous cell carcinoma, most commonly of the lung or head and neck
  • Hematologic malignancy
  • Familial hypocalciuric hypercalcemia – fractional excretion of calcium will be low
  • Hypophosphatasia
  • Immobilization – may cause increased bone turnover
  • Lithium nephropathy
  • Hypervitaminosis D

Best Tests

Subscription Required

Management Pearls

Subscription Required


Subscription Required

Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

Subscription Required


Subscription Required

Last Reviewed:05/08/2019
Last Updated:05/13/2019
Copyright © 2024 VisualDx®. All rights reserved.
Milk-alkali syndrome
A medical illustration showing key findings of Milk-alkali syndrome : Altered mental state, Fatigue, Headache, Nausea, Vomiting, calcium salts, Hypercalcemia, Metabolic alkalosis, Pruritus, Weakness
Copyright © 2024 VisualDx®. All rights reserved.