Hypercalcemia and Upper GI Symptoms

Hypercalcemia is a common clinical presentation encountered in day to day practice. The most common causes of hypercalcemia have been shown to be primary hyperparathyroidism and hypercalcemia of malignancy accounting for around 90% of all cases. We present the case of a 78 year old male admitted to hospital with delirium and an uncommon cause of hypercalcemia, milk alkali syndrome (MAS) in the context of Peptic ulcer disease (PUD). MAS, caused by excessive intake of calcium based antacids, was first identified in the 1920’s when the Sippy regimen, consisting of milk or cream and calcium salts was used to treat peptic ulcers. With the advent of proton pump inhibitors and histamine-2 blockers, it had become a rare cause of hypercalcemia responsible for u003c1% of the cases. However, there has been a re-emergence of MAS due to the increased use of calcium supplements for osteoporosis prevention and over-the-counter preparations for dyspepsia. Interestingly, apart from the well-known classic symptoms of hypercalcemia, chronic hypercalcemia also increases gastric acid production and worsens PUD which in this case, could likely have lead to increased calcium–based antacid ingestion, worsening the hypercalcemia and creating a vicious cycle. This case report explores the physiology of the connection between hypercalcemia and PUD and emphasizes the need to keep MAS on the differential diagnosis for hypercalcemia.