Milk-Alkali Syndrome

Indigestion

Step 1: View clinicals

A 68 year old man presents with polydipsia, polyuria and generalized fatigue for 2 weeks. There is no history of frequency, urgency, dysuria, or other urinary symptoms. He was diagnosed with hypertension and dyslipidemia 5 years ago, for which he is currently on losartan and atorvastatin respectively. He also complains of frequent episodes of 'indigestion', which he treats with large amounts of over the counter antacids and baking soda mixed with water. He drinks socially but does not smoke or use recreational drugs. He was screened for diabetes mellitus last month via a fasting plasma glucose assay, which was found to be 80 mg/dL.


Step 2: Order all relevant investigations

Complete Blood Count

WBC/DC: 8,000/mm3 (4,600-11,000) Hb: 13 mg/dl (11.5 - 18.5) Hct (PCV): 44% (38.8 - 50) Platelets: 210,000/mm3 (150,000-450,000)

Serum Electrolytes

Na+: 139 mEq/L (135-145) K+: 4.5 mEq/L (3.5-5.0) Cl-: 83 mEq/L (96-106) Mg++: 1.9 mEq/L (1.5 - 2.4) Total Ca++: 14.6 mg/dL (8.5 - 10.3) Ionized Ca++: 7.04 mg/dL (4.5 - 5.6) Serum PO4---: 4.3 mg/dL (2.5 - 4.5)

Arterial Blood Gases

pH: 7.54 (7.35-7.45) pCO2: 55 mmHg (35-45) pO2: 70 mmHg (80-100) HCO3: 45 mmol/L (21-28) ABE: 21

Renal Functions

Blood Urea Nitrogen (BUN): 35 mg/dL (8-23) Serum creatinine: 2.5 mg/dL (0.6-1.2)


Step 3: Select appropriate management

IV Pamidronate
IV Fluids
Hemodialysis
Acetazolamide


Score: ★★☆