Milk alkali syndrome without the milk

Case report

A 76 year old woman was referred to a gastroenterology outpatient clinic with altered bowel habit. She had a six month history of alternating constipation and diarrhoea, and she admitted to polydipsia, polyuria, and nocturia. She had no nausea, vomiting, abdominal pain, or weight loss. Her regular prescriptions included salbutamol inhaler, a calcium channel blocker, and ibuprofen for chronic obstructive pulmonary disease, hypertension, and osteoarthritis. She had a history of dyspepsia caused by gastric erosions noted on gastroscopy. She denied taking vitamin supplements or other over the counter medications. Clinical examination was unremarkable, but routine investigations showed hypercalcaemia (table).⇓ She was admitted for immediate treatment with intravenous fluids and intravenous infusion of disodium pamidronate 90 mg. On the second day after admission, her serum calcium concentration was normal. …