Old syndrome and calcium

A LARGELY forgotten disorder that can cause kidney failure is undergoing a resurgence because of growing use of over-the-counter calcium and vitamin D supplements. 

So-called milk-alkali syndrome, caused by a large intake of dairy products along with antacids to control peptic ulcers, has declined with the rise of modern ulcer medications.

But US specialists say a similar syndrome caused by calcium supplements is now the third most common cause of hospital admission for hypercalcaemia.

Postmenopausal and pregnant women were most at risk and it followed growing use of supplements to prevent osteoporosis, they said. The syndrome should be re-named the calcium-alkali syndrome to reflect the new epidemiology, the specialists added.
“The obvious preventive strategy is to limit intake of elemental calcium to no more than 1.2 to 1.5 g/d and to avoid ingesting alkali to reduce the risk,” they wrote.

Nephrologist Associate Pro-fessor Tim Mathew, medical director of Kidney Health Australia, said there was good reason for supplements becoming widespread in order to strengthen bone, but it should be remembered that many older people receiving them often already had reduced kidney function.

“This is an important article sending a signal of concern, but I think at this stage it’s a watching brief,” he said.

Supplements should be used cautiously and monitored in at-risk groups, including postmenopausal or pregnant women, transplant recipients, patients with bulimia and those on dialysis.

J Am Soc Nephrol 2010, in press