PDF(Pubmed)
Abstract：
Milk-alkali syndrome, which is characterized by hypercalcemia, metabolic alkalosis, and renal dysfunction, typically results from the ingestion of large amounts of calcium and absorbable alkaline products. However, these symptoms can also manifest when alkalosis and calcium loading occur simultaneously, owing to other factors. We report a case of milk-alkali syndrome caused by loop-diuretic-induced alkaline load and polypharmacy in an 85-year-old Japanese woman with multiple comorbidities, including osteoporosis, hypertension, type 2 diabetes, dyslipidemia, and Parkinson\'s disease. The patient regularly took 14 drugs, including calcium L-aspartate, eldecalcitol, celecoxib, and a fixed-dose combination of losartan and hydrochlorothiazide. Immediately before admission, furosemide was administered for the treatment of edema. The patient presented with chest discomfort, general malaise, and clinical signs of dehydration, hypercalcemia, hypophosphatemia, hypokalemia, and hypomagnesemia, accompanied by electrocardiogram abnormalities, renal dysfunction, and chloride-resistant metabolic alkalosis. The hypercalcemia was specifically induced by calcium L-aspartate and eldecalcitol. The hypomagnesaemia and hypophosphatemia were caused by diuretics and hypercalcemia. Thus, all the oral medications were discontinued, and rehydration and electrolyte correction therapy were administered. The final diagnosis was milk-alkali syndrome caused by the concomitant use of loop diuretics and other medications, without absorbable alkaline preparation use. This case underscores the importance of considering drug-related factors, checking concomitant medications, and being aware of the benefits, harmful effects, and side effects of polypharmacy in older adults with multimorbidity.
摘要：
奶碱综合征,以高钙血症为特征，代谢性碱中毒，肾功能不全,通常是由于摄入大量的钙和可吸收的碱性产品。然而,当碱中毒和钙负荷同时发生时，这些症状也会表现出来，由于其他因素。我们报告了一名85岁的日本女性，患有多种合并症，由利尿剂引起的碱性负荷和多重用药引起的乳碱综合征，包括骨质疏松症,高血压,2型糖尿病,血脂异常,和帕金森病。患者定期服用14种药物，包括L-天冬氨酸钙,eldecalcitol,塞来昔布,以及氯沙坦和氢氯噻嗪的固定剂量组合。就在入院前，呋塞米用于治疗水肿。病人出现胸部不适,全身不适,和脱水的临床症状，高钙血症,低磷酸盐血症,低钾血症,和低镁血症，伴有心电图异常，肾功能不全,和抗氯化物代谢性碱中毒。高钙血症是由L-天冬氨酸钙和eldecalcitol特异性诱导的。低镁血症和低磷血症是由利尿剂和高钙血症引起的。因此，所有口服药物都停止了，并进行补液和电解质矫正治疗。最终诊断为伴随使用loop利尿剂和其他药物引起的乳碱综合征，无吸收性碱性制剂使用。这个案例强调了考虑药物相关因素的重要性,检查合并用药,意识到好处，有害影响,以及多重性老年人的多重用药副作用。
