Milk-alkali syndrome in pregnancy

Obstet Gynecol. 2004 Nov;104(5 Pt 2):1201-4. doi: 10.1097/01.AOG.0000128109.44291.e2.


Background: Severe hypercalcemia, a potentially life-threatening medical emergency, is rare in pregnancy.

Case: We report a 32-year-old woman presenting early in the second trimester with severe hypercalcemia (total calcium 22 mg/dL), alkalosis, and acute renal insufficiency resulting from excessive ingestion of calcium carbonate-containing antacid for gastroesophageal reflux. The patient was treated with aggressive hydration and furosemide, and received 1 dose of intravenous etidronate, leading to short-term symptomatic hypocalcemia. To our knowledge, this is the third reported case of milk-alkali syndrome in pregnancy.

Conclusion: Milk-alkali syndrome is an uncommon cause of hypercalcemia in pregnancy. Intravenous hydration with saline should be the cornerstone of treatment, reserving bisphosphonates for selected cases.

Publication types

  • Case Reports

MeSH terms

  • Acute Kidney Injury / diagnosis*
  • Acute Kidney Injury / therapy
  • Adult
  • Alkalosis / diagnosis*
  • Alkalosis / therapy
  • Blood Chemical Analysis
  • Combined Modality Therapy
  • Diphosphonates / therapeutic use
  • Female
  • Fluid Therapy / methods
  • Follow-Up Studies
  • Humans
  • Hypercalcemia / diagnosis*
  • Hypercalcemia / therapy
  • Pregnancy
  • Pregnancy Complications / diagnosis*
  • Pregnancy Complications / therapy
  • Pregnancy Outcome*
  • Pregnancy Trimester, Second
  • Rare Diseases
  • Risk Assessment
  • Syndrome


  • Diphosphonates