Milk-alkali syndrome

Mayo Clin Proc. 2009 Mar;84(3):261-7. doi: 10.1016/S0025-6196(11)61144-0.


Milk-alkali syndrome (MAS) consists of hypercalcemia, various degrees of renal failure, and metabolic alkalosis due to ingestion of large amounts of calcium and absorbable alkali. This syndrome was first identified after medical treatment of peptic ulcer disease with milk and alkali was widely adopted at the beginning of the 20th century. With the introduction of histamine2 blockers and proton pump inhibitors, the occurrence of MAS became rare; however, a resurgence of MAS has been witnessed because of the wide availability and increasing use of calcium carbonate, mostly for osteoporosis prevention. The aim of this review was to determine the incidence, pathogenesis, histologic findings, diagnosis, and clinical course of MAS. A MEDLINE search was performed with the keyword milk-alkali syndrome using the PubMed search engine. All relevant English language articles were reviewed. The exact pathomechanism of MAS remains uncertain, but a unique interplay between hypercalcemia and alkalosis in the kidneys seems to lead to a self-reinforcing cycle, resulting in the clinical picture of MAS. Treatment is supportive and involves hydration and withdrawal of the offending agents. Physicians and the public need to be aware of the potential adverse effects of ingesting excessive amounts of calcium carbonate.

Publication types

  • Historical Article
  • Review

MeSH terms

  • Calcium / urine
  • History, 20th Century
  • Humans
  • Hypercalcemia / diagnosis*
  • Hypercalcemia / epidemiology
  • Hypercalcemia / history
  • Hypercalcemia / physiopathology*
  • Incidence
  • Kidney / pathology
  • Parathyroid Hormone / blood
  • Recovery of Function
  • Thiazides / adverse effects


  • Parathyroid Hormone
  • Thiazides
  • Calcium