Our patient is an 81-year-old white male, citizen of United States, who presented to our hospital for a one week history of lethargy and nausea. The day of admission, he developed an acute change in mental status, and became disoriented, confused and somnolent. The patient was known to have hypertension, diabetes mellitus and benign prostate hypertrophy. On physical examination, the patient was severely cachectic and disoriented. His vital signs were in the normal range except for a high blood pressure of 200/100 mmhg.
The initial blood tests on admission showed a creatinine of 8.3 mg/dl and a serum calcium concentration of 14.6 mg/dl. Two months previously the patient had a creatinine of 1.2 mg/dl and a serum calcium concentration of 8.9 mg/dl. In addition, the patient presented with metabolic alkalosis. The admission diagnosis was hypercalcemia leading to acute renal failure and contraction metabolic alkalosis.
After aggressive saline hydration for 2 days, the patient regained his baseline level of consciousness, the serum calcium concentration returned to normal values. However, the glomerular filtration rate did not recover and was still less than 10 ml/min. The patient was started on hemodialysis for 2 sessions and then stopped upon the patient’s request to stop all additional therapy and he opted for hospice care. A repeat laboratory test in four weeks after his hospital discharged showed a glomerular filtration rate of 47 ml/min and a serum creatinine of 1.2 mg/dl implying a spontaneous resolution of his acute renal failure ().
The case happened in Staten Island University Hospital.
The diagnosis was established on a repeat interview with the patient after he regained his orientation in which he admitted taking an estimate of twenty five tablets of calcium carbonate every day as a self medication for osteoporosis prevention. Our final diagnosis is hypercalcemia secondary to milk alkali syndrome.