Milk-alkali syndrome

The Burnett 's syndrome, also called milk - alkali syndrome, is a named after the American physician Charles Hoyt Burnett calcium metabolism disorder due to an excess supply of easily absorbable alkalis ( eg as bicarbonates ) and calcium (eg via milk).

Clinically, Burnett 's syndrome manifests with nausea and vomiting, dizziness and gait disturbance (ataxia). It comes to an alkalosis, an increase in the calcium content in the blood (hypercalcemia ) without increased calcium excretion in the urine and no waste of the phosphate content in the blood. The increased calcium levels leads to calcinosis with Kalksalzablagerungen in the conjunctiva, possibly also in the cornea ( " Bandkeratitis " of the eye opening), as well as in the renal tubules with the risk of the formation of renal insufficiency.

Historical

1915 was first introduced, treatment of stomach ulcers by Bertram Sippy. This was the hourly intake of milk, cream and alkali powders. This therapy resulted in improvement of symptoms, but provided no cure. After introduction of the milk -alkali treatment severe side effects have been increasingly reported, particularly renal failure, alkalosis and hypercalcemia. Especially frequency of these side effects in men with peptic ulcer. There have even been described deaths. With the introduction of better treatment options of gastric and duodenal ulcer, the frequency of milk -alkali syndrome is initially declined.

In the last 15 years the number of cases increases but again, especially in women who take to prevent or treat osteoporosis more than the recommended dose of 1200 to 1500 mg of calcium per day to himself.

Pathogenesis

The metabolic alkalosis stimulates calcium transport in the tubules of the kidney. This, together with an increased supply of calcium to an increase in calcium levels in the blood. The hypercalcemia leads to a narrowing of the blood vessels ( vasoconstriction ) in the kidney, the renal function decreases, and thus the ability of the kidney to excrete excess calcium. The level of parathyroid hormone ( PTH ) decreases. In chronic cases there may be lime deposits in the tissues, particularly in the kidney.

Diagnosis

The most important clue is a history of increased intake of calcium and alkali salts. Laboratory diagnosis results in increased calcium levels ( hypercalcemia ), metabolic alkalosis and impaired renal function. In the classical milk - alkali syndrome due to massive intake of milk and alkali, the phosphate levels increased ( hyperphosphatemia ), the " modern" milk - alkali syndrome due to high doses of calcium carbonate, phosphate levels usually is normal. The parathyroid hormone is decreased. There is often a lack of volume.

Therapy

Completion of the calcium intake, and intravenous infusion of physiological saline resulting in a decrease in the absorption of calcium in the renal tubule system ( by inhibition of the passive tubular reabsorption ), and so a rapid normalization of calcium levels.

Swell

  • P. Olschewski, JP Nordmeyer, T. Scholten: The milk - alkali syndrome - a rare differential diagnosis of hypercalcemia. Dtsch Med Wochenschr 1996; 121 (33 ): 1015-1018
  • Felsenfeld AJ, Levine BS: Milk alkali syndrome and the dynamics of calcium homeostasis .. In: Clin J Am Soc Nephrol No. .. July, 1 (4 ), 2006, pp. 641-654 (Article Abstract).
  • Gabriely, Ilan: Back to Basics. In: N Engl J Med No. 358, 2008, pp. 1952-1956 (Abstract).
  • Metabolic disease
  • Disease in nephrology
Clinical chemistry
155139
de