Kamsi
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A 23-year-old man with a delusional psychiatric illness, a history of chronic dyspepsia, and multiple overdoses in the past decade presents with polyuria and polydipsia. Medications include olanzapine and clonazepam.
Laboratory studies:
Serum creatinine 2.3 mg/dL
Serum bicarbonate 32 meq/L
Serum phosphate 5.8 mg/dL
Serum calcium 12.2 mg/dL
Intact parathyroid hormone <.5 pg/mL (normal, 10-65 pg/mL)
Serum 25-hydroxyvitamin D3 23.2 ng/mL (normal, 9-52 ng/mL)
Serum 1,25-dihydroxyvitamin D3 31 .7 pg/mL (normal, 15-60 pg/mL)
Which of the following ingestions is likely to be the cause of this patients hypercalcemia?
A. Dairy products
B. Calcium carbonate
C. Vitamin D
D. Lithium
E. Famotidine
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| aaroho
Forum Junior
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?A
Milk alkali syndrome-hypercalcemia,renal failure,metabolic alkalosis
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| dr.wad
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B
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| doyoudig
Forum Guru
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D. Lithium
-- if Pt has renal Failure -- LI toxicity can give Sx's if DI
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| cool doctor
Forum Junior
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d-lithium:it may cause hyperCA by increasing the PTH threshold so higher levels are required to shutoff the PTH but here the PTH is already low
B :he has low bicarb levels
C: low levels
so A,E left
the milk-alkali is intersting but I remember that alkalosis causes HYPOcalcemia, am I right?
but I think A is the answer
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| drdg
Forum Senior
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I take A for the answer.
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| neurom
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D
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| Kamsi
Forum Guru
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B
The patient has non-parathyroid-mediated hypercalcemia. His psychiatric illness places him at risk for various ingestions. The constellation of hypercalcemia, metabolic alkalosis, and renal failure strongly suggests the milk-alkali syndrome. In this syndrome, patients have consumed large quantities of both calcium and alkali (such as in calcium carbonate, which is widely available in over-the-counter forms), a combination that significantly decreases renal excretion of calcium and bicarbonate. Parathyroid hormone levels are suppressed, which attenuates urinary phosphate clearance. The resulting hypercalcemia, particularly in conjunction with hyperphosphatemia, increases the risk of nephrocalcinosis and, as a result, renal failure. The decreased glomerular filtration rate may further increase serum calcium and phosphate levels. High calcium diets from dairy products alone should not lead to hypercalcemia in someone with otherwise normal parathyroid status. Vitamin D intoxication could explain both the hypercalcemia and hyperphosphatemia, as well as the renal failure (from nephrocalcinosis). However, hypervitaminosis D is ruled out by the normal 25-hydroxyvitamin D3 level, the best marker of overall vitamin D supply. Lithium therapy or toxicity is also associated with hypercalcemia, although this prescription drug is not easily available to patients. In addition, in lithium-induced hypercalcemia, parathyroid hormone levels are usually normal to high, because lithium decreases the set-point for parathyroid hormone release through effects at the calcium-sensing receptor. Famotidine, a histamine-2 receptor blocker, is not associated with hypercalcemia.
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| cool doctor
Forum Junior
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so milk-alkali is B not A 
I thought daily broducts refer to the milk
Thanks
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