Antacid Abuse: A Case of Milk-Alkali Syndrome

Abstract

Presentation
A 42-year-old man presented with a four-week history of nausea, vomiting, and abdominal pain, ultimately attributed to chronic overuse of calcium carbonate tablets for gastroesophageal reflux disease (GORD).

Diagnosis
Diagnostic evaluation revealed hypercalcaemia, metabolic alkalosis, and acute kidney injury, necessitating intravenous fluid administration and cessation of calcium carbonate tablet consumption. Comprehensive investigations excluded alternative aetiologies, confirming Milk-Alkali Syndrome (MAS).

Treatment
Management involved cessation of calcium carbonate intake, aggressive intravenous fluid administration, and a single 4 mg dose of zoledronic acid. The patient was discharged with esomeprazole. His serum calcium normalised within six days, and creatinine showed further improvement at the 18-month follow-up, underscoring the importance of prompt recognition and intervention.

Discussion
This case emphasizes the need for awareness among healthcare providers regarding MAS as a potential consequence of over-the-counter antacid use and underscores the importance of vigilant medication history review and patient education to prevent MAS-related complications.