The milk-alkali syndrome was originally seen in patients with peptic ulcer disease taking large amounts of milk and sodium bicarbonate (the alkali). As newer therapies for peptic ulcer therapy became available the syndrome became rare. The syndrome may re-emerge with increased calcium intake for osteoporosis.



(1) significant calcium intake, usually 5-15 grams per day (Thakker).

(2) source of absorbable alkali


Sources of calcium:

(1) calcium carbonate (source of calcium as well as absorbable alkali)

(2) dairy products (milk, cheese, yoghurt)

(3) calcium supplements


Calcium carbonate may be found in:

(1) Tums and other calcium carbonate antacids

(2) Tylenol Plus and other oral analgesics combined with an antacid

(3) many other over-the-counter (OTC) preparations


Clinical features:

(1) hypercalcemia

(2) metabolic alkalosis (typically with elevated serum bicarbonate)

(3) nephrocalcinosis

(4) renal insufficiency, which can progress to renal failure

(5) often low serum parathyroid hormone (PTH) levels during hypercalcemia

(6) serum alkaline phosphatase is normal


If a large amount of milk is ingested then the serum phosphorus may be elevated (Beall and Scofield, page 93).


Treatment largely involves significantly reducing calcium and alkali intake and rehydration.


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