SHM Converge Scientific Abstract ePoster Gallery-Got Milk - Tube Feeds With Supplements Leading to Iatrogenic Milk Alkali Syndrome

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This case describes a 60-year-old man who developed severe iatrogenic milk-alkali syndrome after starting gastrostomy tube feeds plus calcium/vitamin D supplementation following major head and neck cancer surgery. He returned to the hospital with two days of altered mental status and fevers. Labs showed marked hypercalcemia (calcium 18.0 mg/dL), metabolic alkalosis (pH 7.50, HCO3 38.3 mmol/L), and acute kidney injury with creatinine rising to 1.2 mg/dL from a baseline of 0.3 mg/dL. Parathyroid hormone was suppressed at 2 pg/mL, while 25-hydroxyvitamin D and PTH-related peptide were normal, supporting a non-malignant, supplement-related cause.<br /><br />The patient had recently undergone total laryngectomy, partial pharyngectomy, and total glossectomy for recurrent laryngeal squamous cell carcinoma. After discharge, he was placed on gastrostomy feeding and also prescribed calcitriol and calcium-vitamin D supplements because of mild hypocalcemia from acquired hypoparathyroidism. His total calcium intake was approximately 6 g/day, including about 1.4 g/day from tube feeds and 4.2 g/day from supplements—around five times the recommended daily intake. Calcitriol likely accelerated the development of hypercalcemia.<br /><br />He was treated with aggressive intravenous fluids, calcitonin, and IV zoledronic acid, and his tube feed formula was changed to one with lower calcium content. His mental status improved quickly, and within four days his calcium normalized and kidney function returned to baseline.<br /><br />The case highlights the risk of milk-alkali syndrome in patients receiving combined tube feeding and calcium/vitamin D supplementation, especially when calcitriol is used. Careful monitoring of total calcium intake is essential.

Asset Subtitle

Ethan Flathers

Meta Tag

Author List Abes Bautista, Ethan Flathers, Lindsey Trinh, Mark Flemmer

Category Clinical Vignettes

Concept Milk-Alkali Syndrome

Concept Hypercalcemia

Concept Metabolic Alkalosis

Concept Acute Kidney Injury

Concept Calcium Intake

Distinguished Finalist

Presenter Organization Macon & Joan Brock Virginia Health Sciences at Old Dominion University

Presenting Author Ethan Flathers

Track Adult

Keywords

milk-alkali syndrome

hypercalcemia

calcium supplementation

calcitriol

gastrostomy tube feeds

metabolic alkalosis

acute kidney injury

hypoparathyroidism

head and neck cancer surgery

iatrogenic toxicity

Milk-Alkali Syndrome

Hypercalcemia

Metabolic Alkalosis

Acute Kidney Injury

Calcium Intake