825:. These new drugs replaced Sippy's diet treatment for peptic ulcers. However, the incidence of milk-alkali syndrome has increased again since the 1990s due to increased osteoporosis awareness and the preventative routine use of calcium supplements. The consumption of calcium supplementation in today's society, mostly to prevent osteoporosis, has aided in the resurgence of milk-alkali syndrome and has sparked conversation about changing the name of milk-alkali syndrome to calcium alkali syndrome as it more accurately reflects the cause of this syndrome. Currently, milk-alkali syndrome is the third most common cause of people hospitalized with
857:. Further research by Cuthbert Cope and Charles H. Burnett revealed varying degrees of milk-alkali syndrome. Cope identified an acute phase which was named Cope's Syndrome while Burnett described a more severe chronic form which was named Burnett's Syndrome. However, both the acute and chronic form of this illness involve renal impairment which is a key contributor to the hypercalcemia seen in people with MAS. Cope and Burnett believe that the kidney damage caused by ingesting high amounts of calcium and alkali occurs first which subsequently makes removal of calcium from the body difficult.
40:
634:
444:(inactive vitamin D); lower calcitriol levels means a lower rate of calcium absorption in the small intestine, which eventually offsets the elevated calcium levels. However, excessive ingestion of calcium of more than 10-15 g per day has been reported to cause calcium levels too high for renal calcitriol suppression to control, resulting in net calcium absorption that ultimately causes hypercalcemia.
716:. Generally, the daily intake of less than 2 grams of calcium is considered to be safe. Prior to starting any calcium supplementation, it is recommended to discuss the individualized calcium requirements of the person. If a person begins a calcium supplementation regimen, they should be educated on the common signs and symptoms of
240:. These abnormal calcium deposits often collect metastatically in the body, including throughout the periarticular tissue, subcutaneous tissue, central nervous system, liver, kidneys, adrenal, bones, and lungs. If ingestion of calcium and alkali is continued, neurologic symptoms such as memory loss, personality changes,
428:
Factors involved in the development of hypercalcemia include excess intestinal absorption of calcium, saturation of the bone's buffering capacity for calcium, decreased renal excretion, and abnormal vitamin D metabolism. Underlying kidney disease is a risk factor for MAS, but even people with healthy
836:
In regards to populations at risk, there has been a shift in the condition's demographic over time. Previously, milk-alkali syndrome was predominantly seen amongst males with ulcers. As new treatments for peptic ulcers arose, there was change in the causation of hypercalcemia. Presently, individuals
795:
or death may result. Long term consumption of large amounts of calcium supplementation associated with milk-alkali syndrome has also been linked to adverse cardiovascular outcomes. It was found that over supplementation of calcium can lead to an increased risk for myocardial infarction and vascular
703:
can develop and the hallmark symptoms to monitor for. Often unknown to the person, calcium can come from many different dietary sources in addition to self- or prescribed-supplementation. Unfortunately, this can lead to the intake of amounts of calcium that exceed recommended doses, causing harmful
341:
Presently, consumption of extensively large amounts of calcium carbonate has replaced the over-ingestion of milk products, or milk and bicarbonate, as the most prominent cause of MAS. Excessive consumption of calcium generally means taking in more than 4 to 5 g of calcium carbonate every day. This
808:
The use of milk and alkali to treat gastric ulcers greatly contributed to the development of milk-alkali syndrome in people but the incidence of milk-alkali syndrome greatly diminished when the true cause of most gastric ulcers was identified and drugs other than antacids were developed to treat
804:
In the early years after the discovery of milk-alkali syndrome, the prevalence of the disease among people treated with Sippy's treatment varied from 2% to 18%. The wide range was attributed to the differing amounts of alkali absorbed among people. In the 1900s, the mortality rate of people with
698:
Increasing education in both people and clinicians surrounding milk-alkali syndrome can help prevent the disease. Over recent years, people have become more aware of the benefits of calcium and how to access it, leading to a consequential rise in cases of milk-alkali syndrome. It is crucial that
188:
The signs and symptoms of milk-alkali syndrome can develop after only a few days and up to several months following the initial ingestion of absorbable calcium and alkali. However, the severity of signs and symptoms of milk-alkali syndrome is largely dependent upon the duration and quantity of
342:
can be attributed to the greater availability of over-the-counter calcium carbonate supplements to treat osteoporosis and dyspepsia, as well as the growing awareness among consumers of the potential health benefits of calcium intake. Calcium carbonate is also often prescribed to people with
853:. This syndrome was discovered in the early 1900s when people began experiencing adverse effects from Bertrand Sippy's gastric ulcer treatment consisting of milk and alkali. Sippy prescribed patients with ulcers milk and alkali, on the theory that ulcers were caused by excessive
425:. In general, milk-alkali syndrome starts with excess calcium levels in the body (hypercalcemia), which causes the body's pH to increase (become more alkaline) resulting in metabolic alkalosis and ultimately contributes to a decrease in renal function.
728:
For mild cases of MAS, the only intervention needed is to withdraw the offending agent. By having the person stop taking any calcium supplements and any other alkali agents they have been taking rapidly corrects hypercalcemia and alkalosis in MAS.
510:
volume. In summary, the symptoms of alkalosis is the net result of over-consumption of absorbable alkali, hypercalcemia-induced hypovolemia, and impaired glomerular filtration rate. Alkalosis, in turn, increases calcium-reabsorption from the
412:
The mechanism of how milk-alkali syndrome develops from ingesting too much of calcium and absorbable alkali is still unclear. However, it is well known that MAS is usually associated with a triad of symptoms that include
1903:
758:
can be used to treat hypercalcemia as it induces caliuresis (excreting calcium in the urine). Standard practice of adequate rehydration and electrolyte monitoring should be used to avoid
176:. Common acute symptoms of milk-alkali syndrome include nausea and vomiting, dry mouth, confusion, lethargy, and distaste for milk. If left untreated, milk-alkali syndrome may lead to
216:, apathy, weakness, confusion, irritability, dry mouth, and repulsion to milk. In individuals with chronic milk-alkali syndrome (Burnett syndrome), symptoms may include muscle aches,
1992:
479:, leading increased sodium excretion followed by water excretion that leads to hypovolemia. Additionally, hypercalcemia can decrease the reabsorption of water in the kidney's
495:, in which calcium-sensing receptors in the PTH gland are activated by the elevated calcium levels to inhibit PTH production, thus decreasing renal reabsorption of calcium.
1301:
U.S. Department of Health and Human
Services, National Institutes of Health, U.S. National Library of Medicine. Last updated Update Date: 7 November 2013 by:Brent Wisse.
791:
In mild cases of milk-alkali syndrome, full recovery is expected and reduction to renal function is reversible. However, in severe cases that are chronic, permanent
610:(BUN), magnesium, and vitamin D levels. Primary hyperparathyroidism has to be excluded. Diagnosis is made by looking at past medical history and laboratory studies.
350:
and to people receiving prolonged corticosteroid therapy that may lead to bone loss, putting them at a higher risk of calcium over-consumption and developing MAS.
1985:
310:(PTH) can show signs of milk-alkali syndrome. Specifically, bicarbonate and pH would be elevated while 1,25-OH vitamin D and PTH would be suppressed.
1978:
2073:
100:
Other disorders that can cause hypercalcemia such as: hyperparathyroidism, malignancies, hyperthyroidism, sarcoidosis, and other malignancies.
1499:
720:
and milk-alkali syndrome, as well as how to reverse the syndrome by discontinuing the offending agent and seeking medical attention.
52:
Vertigo, confusion, apathy, nausea and vomiting, anorexia, tremors, psychosis, myalgia, polyuria, renal calcifications, and pruitus.
267:, a hallmark symptom of milk-alkali syndrome, at early stages of disease progression. Several lab test results, such as elevated
732:
In severe cases, hospitalization may be required to manage this syndrome. Withholding calcium and initiating IV fluids such as
80:
Older age; acute and chronic renal failure; bulimia nervosa; use of certain drugs such as thiazide, NSAIDs, and ACE inhibitors.
279:
and kidney impairment. Histologically, the kidneys of individuals with milk-alkali syndrome have been shown to have "complete
1526:"Hypercalcemia-Induced ST-Segment Elevation Mimicking Acute Myocardial Injury: A Case Report and Review of the Literature"
370:
837:
who are at a higher risk of developing milk-alkali syndrome are pregnant or postmenopausal individuals and the elderly.
2254:
208:. In the acute phase of milk-alkali syndrome (Cope syndrome), the first symptoms of toxicity are nausea, vomiting,
385:, which are absorbable alkali, can also contribute to MAS in those who already consume a large amount of calcium.
2036:
900:"Milk–alkali syndrome is a major cause of hypercalcaemia among non-end-stage renal disease (non-ESRD) inpatients"
650:
An ECG can also be used to diagnose MAS. The following findings related to hypercalcemia could appear on an ECG:
472:
401:
400:
signaling (resulting in hypercalcemia). Calcium carbonate is also commonly used in pregnant individuals to treat
392:(which can cause hypovolemia) and enhanced gastrointestinal calcium absorption as a result of higher levels of
347:
1524:
Abugroun, Ashraf; Tyle, Aneesh; Faizan, Farah; Accavitti, Michael; Ahmed, Chaudhary; Wang, Theodore (2020).
626:
Magnesium: serum magnesium levels are low as hypercalcemia inhibits mg^2+ reabsorption in the renal tubules.
2213:
899:
617:
PTH: low serum PTH levels are indicative of MAS. Low serum PTH levels also exclude primary hyperthyroidism.
90:
Based on physical symptoms, laboratory findings, ECG, and X-ray (to exclude other causes of hypercalcemia).
629:
Vitamin D levels: low vitamin D levels are found. Normal vitamin D levels eliminate primary hypercalcemia.
2233:
518:
Altogether, these result in a cycle of hypercalcemia, alkalosis, and renal injury characteristic of MAS.
1253:
452:
374:
318:
Milk-alkali syndrome is caused by ingesting excessive amounts of both calcium (usually in the form of
503:
1252:
Irtiza-Ali, Ayesha; Waldek, Stephen; Lamerton, Elizabeth; Pennell, Ashley; Kalra, Philip A. (2008).
2264:
2041:
2007:
512:
748:
of 100 - 150 mL/h. However, the rate is variable depending on the individual's age, renal status,
602:
Lab work must be done to diagnose milk-alkali syndrome. Lab workup includes serum calcium levels,
432:
For a healthy individual, if calcium levels are high, the kidneys will decrease its production of
2160:
2046:
1832:"Milk-alkali syndrome: a historical review and description of the modern version of the syndrome"
57:
1069:
1391:
Zayed, Randa F.; Millhouse, Paul W.; Kamyab, Farnaz; Ortiz, Juan
Fernando; Atoot, Adam (2021).
480:
389:
343:
95:
1947:
1302:
2051:
1601:
822:
468:
362:
257:
1617:
740:. The initial rate of infusion is generally around 200-300 mL/h in people not experiencing
484:
456:
173:
1970:
8:
2131:
1958:
1907:
1771:
Rehan, Mehboob A.; Rashid, Asma; Krell, Kenneth; Gabutti, Cristina; Singh, Reema (2020).
850:
763:
643:
607:
603:
535:
507:
499:
488:
460:
422:
382:
378:
319:
307:
284:
280:
268:
165:
146:
142:
1588:
530:
must be ruled out. Other causes of hypercalcemia can include elevated vitamin D levels,
160:. Sources of calcium and alkali include dietary supplements taken for the prevention of
2269:
2058:
1912:
1867:
1807:
1772:
1748:
1723:
1696:
1661:
1637:
1560:
1525:
1481:
1427:
1392:
1354:
1234:
1026:
1001:
935:
397:
192:
Acute milk-alkali syndrome is characterized by several biochemical alterations, mainly
47:
1451:
1324:
2151:
2107:
1918:
1859:
1851:
1847:
1830:
Beall, Douglas P.; Henslee, Heidi B.; Webb, Heather R.; Scofield, R. Hal (May 2006).
1812:
1794:
1753:
1701:
1683:
1629:
1621:
1565:
1547:
1473:
1432:
1414:
1346:
1281:
1273:
1269:
1226:
1218:
1169:
1097:
1089:
1031:
927:
919:
915:
733:
492:
323:
85:
1871:
1641:
1485:
1393:"Calcium-Alkali Syndrome: Historical Review, Pathophysiology and Post-Modern Update"
1238:
939:
108:
Decrease calcium intake (1.2-1.5 g/daily for individuals with risk factors for MAS).
2259:
2063:
1843:
1802:
1784:
1743:
1735:
1691:
1673:
1613:
1555:
1537:
1463:
1422:
1404:
1336:
1265:
1254:"MILK ALKALI SYNDROME ASSOCIATED WITH EXCESSIVE INGESTION OF RENNIE®: CASE REPORTS"
1210:
1081:
1021:
1013:
911:
567:
233:
209:
1358:
873:
769:
If kidney failure is advanced then treatment for that is required, namely chronic
447:
Hypercalcemia affects the kidneys in multiple ways that altogether contributes to
404:, further putting them at risk for overconsumption of calcium and developing MAS.
2174:
2126:
2093:
2031:
1602:"Narrative Review: Furosemide for Hypercalcemia: An Unproven yet Common Practice"
770:
531:
354:
2156:
1161:
1085:
846:
792:
717:
709:
705:
700:
687:
527:
414:
264:
253:
205:
1923:
116:
Withdrawal of the offending agent, hydration, hemodialysis (in extreme cases).
39:
2248:
2193:
2068:
2026:
1855:
1798:
1687:
1625:
1551:
1418:
1277:
1222:
1093:
923:
826:
814:
587:
476:
366:
237:
197:
177:
138:
134:
1831:
1863:
1816:
1757:
1705:
1633:
1569:
1542:
1477:
1436:
1350:
1341:
1285:
1173:
1035:
931:
854:
776:
745:
327:
161:
1230:
1101:
357:, which cause increased reabsorption of calcium in the kidneys; resulting
353:
Other drugs reported to be associated with the development of MAS include
1942:
1789:
1468:
1409:
749:
737:
683:
464:
448:
441:
358:
295:
201:
75:
526:
Prior to an official diagnosis of milk-alkali syndrome, other causes of
487:, contributing to more hypovolemia. Hypercalcemia also results in lower
1214:
780:
755:
679:
433:
272:
225:
1895:
1678:
623:
Creatinine and BUN: high levels can indicate severity of renal damage.
388:
Pregnant individuals have an increased risk for developing MAS due to
1953:
1739:
1198:
1017:
810:
759:
713:
575:
551:
515:
of the nephron, thus exacerbating the hypercalcemia and hypovolemia.
437:
418:
393:
303:
217:
193:
898:
Picolos, Michalis K.; Lavis, Victor R.; Orlander, Philip R. (2005).
377:(GFR) and thus reduce calcium excretion. Taking medications such as
591:
583:
563:
276:
241:
221:
169:
654:
Short QT interval: most commonly seen as short OoT or OaT changes.
373:(NSAIDs) are also drugs associated with MAS because they decrease
579:
547:
335:
288:
213:
153:
1660:
Patel, Ami M.; Adeseun, Gbemisola A.; Goldfarb, Stanley (2013).
633:
252:
will persistently develop over time, as a result of the extreme
1251:
830:
663:
571:
559:
555:
331:
245:
157:
1452:"Milk Alkali Syndrome and the Dynamics of Calcium Homeostasis"
708:, supplementation of calcium can more easily result in deadly
699:
people are educated by their healthcare provider(s) about how
152:
Milk-alkali syndrome can be caused by the excessive intake of
741:
845:
Milk-alkali syndrome is an illness that is characterized by
2000:
1523:
291:, vascular changes, and diffuse lymphocytic infiltration."
249:
229:
141:). Milk-alkali syndrome is characterized by hypercalcemia,
1390:
70:
Intake of large amounts of calcium and absorbable alkali.
1829:
1773:"Calcium Alkali Thiazide Syndrome: What We Need to Know"
1587:
Scofield RH et al. for eMedicine. Updated: 12 Aug, 2014
874:"Milk-alkali syndrome: MedlinePlus Medical Encyclopedia"
263:
People with milk-alkali syndrome commonly show signs of
16:
Symptoms due to excess consumption of calcium and alkali
1770:
620:
Phosphorus: low serum phosphorus levels due to low PTH.
299:
1600:
LeGrand, Susan B.; Leskuski, Dona; Zama, Ivan (2008).
1456:
Clinical
Journal of the American Society of Nephrology
1325:"Got Calcium? Welcome to the Calcium-Alkali Syndrome"
1885:
1659:
897:
704:
effects. Particularly in persons with any degree of
1599:
1450:Felsenfeld, Arnold J.; Levine, Barton S. (2006).
2246:
1449:
614:Serum calcium levels: high serum calcium levels.
294:Other laboratory tests, such as measuring serum
1168:, Treasure Island (FL): StatPearls Publishing,
2074:Neurodegeneration with brain iron accumulation
367:Angiotensin-converting enzyme (ACE) inhibitors
326:, which is commonly taken to prevent or treat
1986:
1329:Journal of the American Society of Nephrology
1322:
1297:
1295:
1196:
133:, is the third most common cause of elevated
1836:The American Journal of the Medical Sciences
1583:
1581:
1579:
1070:"The Milk-Alkali Syndrome: Current Concepts"
1721:
1662:"Calcium-Alkali Syndrome in the Modern Era"
1197:Texter, E. Clinton; Laureta, H. C. (1966).
995:
993:
991:
989:
987:
985:
983:
981:
979:
977:
975:
973:
971:
969:
805:milk-alkali syndrome was found to be 4.4%.
224:(producing large volumes of dilute urine),
1993:
1979:
1292:
1203:The American Journal of Digestive Diseases
999:
967:
965:
963:
961:
959:
957:
955:
953:
951:
949:
38:
1806:
1788:
1747:
1695:
1677:
1576:
1559:
1541:
1467:
1426:
1408:
1340:
1323:Patel, Ami M.; Goldfarb, Stanley (2010).
1025:
1159:
632:
2001:Metal deficiency and toxicity disorders
1618:10.7326/0003-4819-149-4-200808190-00007
946:
451:. Prolonged hypercalcemia can decrease
2247:
1067:
502:(increase in blood pH) by stimulating
1974:
1717:
1715:
1655:
1653:
1651:
1386:
1384:
1382:
1380:
1378:
1376:
1374:
1372:
1370:
1368:
1155:
1153:
1151:
1149:
1147:
1145:
1143:
1141:
1139:
1137:
1135:
1133:
1131:
752:, and the severity of hypercalcemia.
657:Prolongation of PR and QRS intervals.
371:non-steroidal anti-inflammatory drugs
183:
1722:Medarov, MD, Boris I. (March 2009).
1318:
1316:
1314:
1312:
1310:
1192:
1190:
1188:
1160:Ali, Rimsha; Patel, Chinmay (2021),
1129:
1127:
1125:
1123:
1121:
1119:
1117:
1115:
1113:
1111:
1063:
1061:
1059:
1057:
1055:
1053:
1051:
1049:
1047:
1045:
485:antidiuretic hormone (ADH) receptors
813:, such as acid-reducing drugs like
660:Increased Amplitude of QRS complex.
455:(GFR) via vasoconstriction, reduce
440:) by reducing the hydroxylation of
13:
1712:
1648:
1530:Case Reports in Emergency Medicine
1365:
1303:Medline Plus: Milk-alkali syndrome
678:Chest x-rays can help exclude any
590:such as renal calcifications, and
429:kidneys can develop the syndrome.
14:
2281:
1881:
1307:
1185:
1108:
1042:
283:hyalinization, thickening of the
1848:10.1097/00000441-200605000-00001
1270:10.1111/j.1755-6686.2008.00018.x
916:10.1111/j.1365-2265.2005.02383.x
829:, after hyperparathyroidism and
744:then it is adjusted to maintain
1823:
1764:
1593:
1589:eMedicine: Milk-Alkali Syndrome
1517:
1492:
1443:
799:
606:(PTH), phosphorus, creatinine,
1245:
891:
866:
779:agents may be necessary, e.g.
1:
860:
693:
594:could be observed in people.
348:secondary hyperparathyroidism
189:calcium and alkali ingested.
2214:Acrodermatitis enteropathica
723:
521:
463:. Hypercalcemia also causes
407:
7:
2234:Inborn errors of metabolism
1606:Annals of Internal Medicine
1074:Annals of Internal Medicine
786:
232:(itchy sensation on skin),
10:
2286:
2052:African iron overload/HFE4
1199:"The milk-alkali syndrome"
1086:10.7326/0003-4819-97-2-242
840:
498:Hypovolemia then leads to
453:glomerular filtration rate
375:glomerular filtration rate
2226:
2202:
2182:
2173:
2140:
2115:
2106:
2082:
2015:
2006:
1933:
1889:
313:
269:blood urea nitrogen (BUN)
112:
104:
94:
84:
74:
66:
56:
46:
37:
29:
24:
2255:Electrolyte disturbances
1068:Orwoll, Eric S. (1982).
504:bicarbonate reabsorption
471:(NKCC) in the medullary
2161:Occipital horn syndrome
1728:Mayo Clinic Proceedings
459:, and eventually cause
212:, headache, dizziness,
131:calcium-alkali syndrome
129:), also referred to as
33:Calcium-alkali syndrome
1724:"Milk-Alkali Syndrome"
1504:Cancer Therapy Advisor
1500:"Milk-Alkali Syndrome"
1342:10.1681/ASN.2010030255
1162:"Milk-Alkali Syndrome"
1002:"Milk-alkali syndrome"
904:Clinical Endocrinology
823:proton pump inhibitors
638:
493:negative feedback loop
346:for the prevention of
344:chronic kidney disease
275:, are illustrative of
258:electrolyte imbalances
96:Differential diagnosis
1258:Journal of Renal Care
849:, kidney damage, and
819:-receptor antagonists
636:
542:Physical Examination:
506:in order to maintain
469:Na-K-Cl cotransporter
363:contraction alkalosis
62:Renal failure, death.
2037:Hemochromatosis/HFE1
1790:10.7759/cureus.10856
1543:10.1155/2020/4159526
1469:10.2215/CJN.01451005
1410:10.7759/cureus.13291
686:when evaluating for
642:Electrocardiograms (
473:thick ascending limb
457:creatinine clearance
174:peptic ulcer disease
123:Milk-alkali syndrome
25:Milk-alkali syndrome
1000:Medarov BI (2009).
851:metabolic alkalosis
764:renal insufficiency
608:blood urea nitrogen
604:parathyroid hormone
536:hyperparathyroidism
500:metabolic alkalosis
491:(PTH) levels via a
489:parathyroid hormone
461:renal insufficiency
423:acute kidney injury
383:magnesium hydroxide
320:dietary supplements
308:parathyroid hormone
166:hyperparathyroidism
147:acute kidney injury
143:metabolic alkalosis
2059:Aceruloplasminemia
1934:External resources
1215:10.1007/BF02233637
827:high blood calcium
639:
379:aluminum hydroxide
355:thiazide diuretics
228:(intense thirst),
184:Signs and symptoms
2242:
2241:
2222:
2221:
2169:
2168:
2152:Copper deficiency
2102:
2101:
1968:
1967:
1679:10.3390/nu5124880
1672:(12): 4880–4893.
668:Short ST segment.
546:Symptoms such as
398:placental lactose
334:(as are found in
330:) and absorbable
324:calcium carbonate
265:renal dysfunction
120:
119:
86:Diagnostic method
19:Medical condition
2277:
2207:
2187:
2180:
2179:
2145:
2132:Wilson's disease
2120:
2113:
2112:
2087:
2064:Atransferrinemia
2020:
2013:
2012:
1995:
1988:
1981:
1972:
1971:
1887:
1886:
1876:
1875:
1827:
1821:
1820:
1810:
1792:
1768:
1762:
1761:
1751:
1740:10.4065/84.3.261
1719:
1710:
1709:
1699:
1681:
1657:
1646:
1645:
1597:
1591:
1585:
1574:
1573:
1563:
1545:
1521:
1515:
1514:
1512:
1511:
1496:
1490:
1489:
1471:
1447:
1441:
1440:
1430:
1412:
1388:
1363:
1362:
1344:
1335:(9): 1440–1443.
1320:
1305:
1299:
1290:
1289:
1249:
1243:
1242:
1194:
1183:
1182:
1181:
1180:
1157:
1106:
1105:
1065:
1040:
1039:
1029:
1018:10.4065/84.3.261
997:
944:
943:
895:
889:
888:
886:
884:
870:
481:collecting ducts
467:by blocking the
285:Bowman's capsule
234:band keratopathy
42:
22:
21:
2285:
2284:
2280:
2279:
2278:
2276:
2275:
2274:
2265:Kidney diseases
2245:
2244:
2243:
2238:
2218:
2203:
2198:
2183:
2165:
2141:
2136:
2127:Copper toxicity
2116:
2098:
2094:Iron deficiency
2083:
2078:
2032:Hemochromatosis
2016:
2002:
1999:
1969:
1964:
1963:
1929:
1928:
1898:
1884:
1879:
1828:
1824:
1769:
1765:
1720:
1713:
1658:
1649:
1598:
1594:
1586:
1577:
1522:
1518:
1509:
1507:
1498:
1497:
1493:
1448:
1444:
1389:
1366:
1321:
1308:
1300:
1293:
1250:
1246:
1195:
1186:
1178:
1176:
1158:
1109:
1066:
1043:
998:
947:
896:
892:
882:
880:
878:medlineplus.gov
872:
871:
867:
863:
843:
818:
802:
796:calcification.
789:
726:
696:
532:hyperthyroidism
524:
483:by suppressing
410:
316:
186:
180:or even death.
156:and absorbable
20:
17:
12:
11:
5:
2283:
2273:
2272:
2267:
2262:
2257:
2240:
2239:
2237:
2236:
2230:
2228:
2224:
2223:
2220:
2219:
2217:
2216:
2210:
2208:
2200:
2199:
2197:
2196:
2190:
2188:
2177:
2171:
2170:
2167:
2166:
2164:
2163:
2157:Menkes disease
2154:
2148:
2146:
2138:
2137:
2135:
2134:
2129:
2123:
2121:
2110:
2104:
2103:
2100:
2099:
2097:
2096:
2090:
2088:
2080:
2079:
2077:
2076:
2071:
2066:
2061:
2056:
2055:
2054:
2049:
2044:
2039:
2029:
2023:
2021:
2010:
2004:
2003:
1998:
1997:
1990:
1983:
1975:
1966:
1965:
1962:
1961:
1959:article/123324
1950:
1938:
1937:
1935:
1931:
1930:
1927:
1926:
1915:
1899:
1894:
1893:
1891:
1890:Classification
1883:
1882:External links
1880:
1878:
1877:
1842:(5): 233–242.
1822:
1783:(10): e10856.
1763:
1734:(3): 261–267.
1711:
1647:
1612:(4): 259–263.
1592:
1575:
1516:
1491:
1462:(4): 641–654.
1442:
1364:
1306:
1291:
1244:
1209:(5): 413–418.
1184:
1107:
1080:(2): 242–248.
1041:
1006:Mayo Clin Proc
945:
910:(5): 566–576.
890:
864:
862:
859:
847:hypercalcaemia
842:
839:
816:
801:
798:
793:kidney failure
788:
785:
725:
722:
695:
692:
670:
669:
666:
661:
658:
655:
631:
630:
627:
624:
621:
618:
615:
588:calcifications
523:
520:
513:distal tubules
409:
406:
315:
312:
238:calcifications
185:
182:
178:kidney failure
118:
117:
114:
110:
109:
106:
102:
101:
98:
92:
91:
88:
82:
81:
78:
72:
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68:
64:
63:
60:
54:
53:
50:
44:
43:
35:
34:
31:
27:
26:
18:
15:
9:
6:
4:
3:
2:
2282:
2271:
2268:
2266:
2263:
2261:
2258:
2256:
2253:
2252:
2250:
2235:
2232:
2231:
2229:
2225:
2215:
2212:
2211:
2209:
2206:
2201:
2195:
2194:Zinc toxicity
2192:
2191:
2189:
2186:
2181:
2178:
2176:
2172:
2162:
2158:
2155:
2153:
2150:
2149:
2147:
2144:
2139:
2133:
2130:
2128:
2125:
2124:
2122:
2119:
2114:
2111:
2109:
2105:
2095:
2092:
2091:
2089:
2086:
2081:
2075:
2072:
2070:
2069:Hemosiderosis
2067:
2065:
2062:
2060:
2057:
2053:
2050:
2048:
2045:
2043:
2042:Juvenile/HFE2
2040:
2038:
2035:
2034:
2033:
2030:
2028:
2027:Iron overload
2025:
2024:
2022:
2019:
2014:
2011:
2009:
2005:
1996:
1991:
1989:
1984:
1982:
1977:
1976:
1973:
1960:
1956:
1955:
1951:
1949:
1945:
1944:
1940:
1939:
1936:
1932:
1925:
1921:
1920:
1916:
1914:
1910:
1909:
1905:
1901:
1900:
1897:
1892:
1888:
1873:
1869:
1865:
1861:
1857:
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1837:
1833:
1826:
1818:
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1800:
1796:
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1786:
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1778:
1774:
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1755:
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1718:
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1703:
1698:
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1680:
1675:
1671:
1667:
1663:
1656:
1654:
1652:
1643:
1639:
1635:
1631:
1627:
1623:
1619:
1615:
1611:
1607:
1603:
1596:
1590:
1584:
1582:
1580:
1571:
1567:
1562:
1557:
1553:
1549:
1544:
1539:
1535:
1531:
1527:
1520:
1505:
1501:
1495:
1487:
1483:
1479:
1475:
1470:
1465:
1461:
1457:
1453:
1446:
1438:
1434:
1429:
1424:
1420:
1416:
1411:
1406:
1403:(2): e13291.
1402:
1398:
1394:
1387:
1385:
1383:
1381:
1379:
1377:
1375:
1373:
1371:
1369:
1360:
1356:
1352:
1348:
1343:
1338:
1334:
1330:
1326:
1319:
1317:
1315:
1313:
1311:
1304:
1298:
1296:
1287:
1283:
1279:
1275:
1271:
1267:
1263:
1259:
1255:
1248:
1240:
1236:
1232:
1228:
1224:
1220:
1216:
1212:
1208:
1204:
1200:
1193:
1191:
1189:
1175:
1171:
1167:
1163:
1156:
1154:
1152:
1150:
1148:
1146:
1144:
1142:
1140:
1138:
1136:
1134:
1132:
1130:
1128:
1126:
1124:
1122:
1120:
1118:
1116:
1114:
1112:
1103:
1099:
1095:
1091:
1087:
1083:
1079:
1075:
1071:
1064:
1062:
1060:
1058:
1056:
1054:
1052:
1050:
1048:
1046:
1037:
1033:
1028:
1023:
1019:
1015:
1011:
1007:
1003:
996:
994:
992:
990:
988:
986:
984:
982:
980:
978:
976:
974:
972:
970:
968:
966:
964:
962:
960:
958:
956:
954:
952:
950:
941:
937:
933:
929:
925:
921:
917:
913:
909:
905:
901:
894:
879:
875:
869:
865:
858:
856:
852:
848:
838:
834:
832:
828:
824:
820:
812:
806:
797:
794:
784:
782:
778:
774:
772:
767:
765:
761:
757:
753:
751:
750:comorbidities
747:
743:
739:
735:
730:
721:
719:
718:hypercalcemia
715:
711:
710:hypercalcemia
707:
706:renal disease
702:
701:hypercalcemia
691:
689:
688:hypercalcemia
685:
681:
676:
674:
667:
665:
662:
659:
656:
653:
652:
651:
648:
647:
645:
637:ECG intervals
635:
628:
625:
622:
619:
616:
613:
612:
611:
609:
605:
600:
599:
595:
593:
589:
585:
581:
577:
573:
569:
565:
561:
557:
553:
549:
544:
543:
539:
537:
533:
529:
528:hypercalcemia
519:
516:
514:
509:
508:extracellular
505:
501:
496:
494:
490:
486:
482:
478:
477:loop of Henle
474:
470:
466:
462:
458:
454:
450:
445:
443:
439:
435:
430:
426:
424:
420:
416:
415:hypercalcemia
405:
403:
399:
395:
391:
386:
384:
380:
376:
372:
368:
364:
360:
356:
351:
349:
345:
339:
337:
333:
329:
325:
321:
311:
309:
305:
301:
297:
292:
290:
286:
282:
278:
274:
271:and elevated
270:
266:
261:
259:
255:
254:hypercalcemia
251:
247:
243:
239:
236:and abnormal
235:
231:
227:
223:
219:
215:
211:
207:
206:hypercalcemia
203:
199:
198:hypochloremia
195:
190:
181:
179:
175:
171:
167:
163:
159:
155:
150:
148:
144:
140:
139:hypercalcemia
136:
135:blood calcium
132:
128:
124:
115:
111:
107:
103:
99:
97:
93:
89:
87:
83:
79:
77:
73:
69:
65:
61:
59:
58:Complications
55:
51:
49:
45:
41:
36:
32:
28:
23:
2204:
2184:
2142:
2117:
2084:
2017:
1952:
1941:
1917:
1902:
1839:
1835:
1825:
1780:
1776:
1766:
1731:
1727:
1669:
1665:
1609:
1605:
1595:
1533:
1529:
1519:
1508:. Retrieved
1506:. 2019-01-17
1503:
1494:
1459:
1455:
1445:
1400:
1396:
1332:
1328:
1264:(2): 64–67.
1261:
1257:
1247:
1206:
1202:
1177:, retrieved
1165:
1077:
1073:
1012:(3): 261–7.
1009:
1005:
907:
903:
893:
881:. Retrieved
877:
868:
855:gastric acid
844:
835:
807:
803:
800:Epidemiology
790:
777:Calcimimetic
775:
768:
754:
746:urine output
731:
727:
697:
677:
672:
671:
649:
641:
640:
601:
597:
596:
545:
541:
540:
525:
517:
497:
446:
431:
427:
411:
387:
361:can lead to
352:
340:
328:osteoporosis
317:
293:
262:
191:
187:
162:osteoporosis
151:
130:
126:
122:
121:
76:Risk factors
2205:deficiency:
2143:deficiency:
2085:deficiency:
1943:MedlinePlus
738:hypovolemia
736:to correct
684:sarcoidosis
664:Osborn wave
586:, abnormal
465:natriuresis
449:hypovolemia
402:acid reflux
390:hyperemesis
359:hypovolemia
296:bicarbonate
202:hypokalemia
30:Other names
2249:Categories
1919:DiseasesDB
1510:2021-07-27
1179:2021-08-04
1166:StatPearls
861:References
781:Cinacalcet
756:Furosemide
694:Prevention
680:malignancy
434:calcitriol
302:, 1,25-OH
287:, tubular
281:glomerulus
273:creatinine
226:polydipsia
220:, tremor,
172:taken for
105:Prevention
2270:Syndromes
1954:eMedicine
1856:0002-9629
1799:2168-8184
1688:2072-6643
1666:Nutrients
1626:0003-4819
1552:2090-648X
1419:2168-8184
1278:1755-6678
1223:1573-2568
1094:0003-4819
924:1365-2265
811:heartburn
760:alkalosis
724:Treatment
714:alkalosis
673:Radiology
598:Lab work:
576:psychosis
552:confusion
522:Diagnosis
442:calcidiol
438:vitamin D
419:alkalosis
408:Mechanism
394:prolactin
304:vitamin D
218:psychosis
194:alkalosis
113:Treatment
1872:45802184
1864:16702792
1817:33178509
1758:19252114
1706:24288027
1642:46460077
1634:18711156
1570:32257460
1486:26391484
1478:17699269
1437:33732556
1351:20413609
1286:18498570
1239:39190142
1174:32491432
1036:19252114
940:26770851
932:16268810
883:16 April
787:Outcomes
771:dialysis
592:pruritus
584:polyuria
568:anorexia
564:vomiting
436:(active
338:drugs).
322:such as
277:azotemia
242:lethargy
230:pruritus
222:polyuria
210:anorexia
170:antacids
137:levels (
48:Symptoms
2260:Calcium
2185:excess:
2118:excess:
2018:excess:
1808:7652029
1749:2664604
1697:3875933
1561:7102466
1536:: 1–5.
1428:7955894
1231:5327389
1102:7049033
1027:2664604
841:History
580:myalgia
572:tremors
548:vertigo
475:of the
336:antacid
289:atrophy
214:vertigo
154:calcium
2108:Copper
1948:000332
1913:275.42
1870:
1862:
1854:
1815:
1805:
1797:
1777:Cureus
1756:
1746:
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1686:
1640:
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1558:
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1417:
1397:Cureus
1359:356920
1357:
1349:
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1276:
1237:
1229:
1221:
1172:
1100:
1092:
1034:
1024:
938:
930:
922:
831:cancer
734:saline
560:nausea
556:apathy
534:, and
421:, and
332:alkali
314:Causes
306:, and
248:, and
246:stupor
204:, and
158:alkali
145:, and
67:Causes
2227:Other
1868:S2CID
1638:S2CID
1482:S2CID
1355:S2CID
1235:S2CID
936:S2CID
742:edema
2175:Zinc
2047:HFE3
2008:Iron
1924:8215
1908:9-CM
1860:PMID
1852:ISSN
1813:PMID
1795:ISSN
1754:PMID
1702:PMID
1684:ISSN
1630:PMID
1622:ISSN
1566:PMID
1548:ISSN
1534:2020
1474:PMID
1433:PMID
1415:ISSN
1347:PMID
1282:PMID
1274:ISSN
1227:PMID
1219:ISSN
1170:PMID
1098:PMID
1090:ISSN
1032:PMID
928:PMID
920:ISSN
885:2019
762:and
712:and
562:and
381:and
369:and
256:and
250:coma
168:and
1904:ICD
1844:doi
1840:331
1803:PMC
1785:doi
1744:PMC
1736:doi
1692:PMC
1674:doi
1614:doi
1610:149
1556:PMC
1538:doi
1464:doi
1423:PMC
1405:doi
1337:doi
1266:doi
1211:doi
1082:doi
1022:PMC
1014:doi
912:doi
821:or
682:or
644:ECG
396:or
164:or
127:MAS
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