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Antacid Abuse - A Case of Milk-Alkali Syndrome

Varghese S, Cinnamond K, Malek B, et al. (2026)

Ir Med J · PMID 42180434

Abstract

PRESENTATION: A 42-year-old man presented with a four-week history of nausea, vomiting, and abdominal pain, ultimately attributed to chronic overuse of calcium carbonate tablets for gastroesophageal reflux disease (GORD). DIAGNOSIS: Diagnostic evaluation revealed hypercalcaemia, metabolic alkalosis, and acute kidney injury, necessitating intravenous fluid administration and cessation of calcium carbonate tablet consumption. Comprehensive investigations excluded alternative aetiologies, confirming Milk-Alkali Syndrome (MAS). TREATMENT: Management involved cessation of calcium carbonate intake, aggressive intravenous fluid administration, and a single 4 mg dose of zoledronic acid. The patient was discharged with esomeprazole. His serum calcium normalised within six days, and creatinine showed further improvement at the 18-month follow-up, underscoring the importance of prompt recognition and intervention. DISCUSSION: This case emphasizes the need for awareness among healthcare providers regarding MAS as a potential consequence of over-the-counter antacid use and underscores the importance of vigilant medication history review and patient education to prevent MAS-related complications.