scholarly journals Antacids, Altered Mental Status, and Milk-Alkali Syndrome

2012 ◽  
Vol 2012 ◽  
pp. 1-3
Author(s):  
Simon C. Watson ◽  
Bonnie B. Dellinger ◽  
Katie Jennings ◽  
Lancer A. Scott
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Peptic Ulcer ◽  
Mental Status ◽  
Proton Pump ◽  
Metabolic Alkalosis ◽  
Altered Mental Status ◽  
Ulcer Disease ◽  
Calcium Supplements ◽  
Patients At Risk

The frequency of milk-alkali syndrome decreased rapidly after the development of histamine-2 antagonists and proton pump inhibitors for the treatment of peptic ulcer disease; however, the availability and overconsumption of antacids and calcium supplements can still place patients at risk (D. P. Beall et al., 2006). Here we describe a patient who presented with altered mental status, hypercalcemia, metabolic alkalosis, and acute renal failure in the context of ingesting large amounts of antacids to control dyspepsia.

scholarly journals PROLONGED HYPERCALCEMIA FROM ANTIBIOTIC-ELUTING CALCIUM SULFATE BEADS

2019 ◽  
Vol 5 (6) ◽  
pp. e349-e351 ◽  
Author(s):  
Amy Vora ◽  
Sadia Ali
Keyword(s):  
Renal Failure ◽  
Mental Status ◽  
Serum Calcium ◽  
Calcium Sulfate ◽  
Volume Overload ◽  
Altered Mental Status ◽  
Caucasian Woman ◽  
Local Antibiotics ◽  
Joint Infections ◽  
Severe Hypercalcemia

Objective: Calcium sulfate beads (CSBs) are biocompatible hydrophilic crystals that are used to deliver local antibiotics in periprosthetic joint infections. Hypercalcemia after placement of CSBs is uncommon and poorly understood. Methods: We present the case of a woman who presented with symptomatic hypercalcemia after placement of antibiotic-eluting CSBs. Results: A 58-year-old, Caucasian woman presented with altered mental status, respiratory failure, and septic shock 2 days after placement of antibiotic-eluting CSBs for a left prosthetic hip infection. Laboratory analysis revealed severe hypercalcemia at presentation. She had no known history of fractures, kidney stones, parathyroid, or calcium disorders. She was not on any medications that could induce hypercalcemia. She was treated with aggressive intravenous hydration and 8 doses of calcitonin. Due to impaired renal function, bisphosphonate was contraindicated. She subsequently became anuric with worsening renal failure and volume overload and the decision was made to initiate dialysis. She received 8 days of continuous renal replacement therapy followed by 2 sessions of hemodialysis which improved her serum calcium levels, mental status, and renal failure with no long-term complications. Conclusion: Hypercalcemia secondary to the placement of antibiotic-eluting CSBs is rare. Larger volumes of CSBs may contribute to hypercalcemia. In some cases, hypercalcemia can be severe and symptomatic as in the case of our patient. Serum calcium levels should be monitored frequently after placement of CSBs and managed as appropriate.

scholarly journals Proton Pump Inhibition is a Feasible Primary Alternative to Surgery and Balloon Dilatation in Adult Peptic Pyloric Stenosis (APS): Report of Six Consecutive Cases

2006 ◽  
Vol 88 (2) ◽  
pp. 174-175 ◽  
Author(s):  
J Shabbir ◽  
S Durrani ◽  
PF Ridgway ◽  
K Mealy
Keyword(s):  
Peptic Ulcer ◽  
Peptic Ulcer Disease ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Pyloric Stenosis ◽  
Median Duration ◽  
Oral Treatment ◽  
Duration Of Symptoms ◽  
Ulcer Disease ◽  
Proton Pump Inhibition

INTRODUCTION Surgery has been the gold standard in the treatment of adult pyloric stenosis (APS). The introduction of proton pump inhibitors (PPIs) in 1989 revolutionised the treatment of peptic ulcer disease and its complications. PATIENTS AND METHODS We carried out a prospective study to evaluate the effectiveness of PPIs as an alternative to surgery for treatment of APS. Six consecutive patients admitted with a diagnosis of adult peptic pyloric stenosis between November 1999 and August 2002 were studied. The diagnosis was confirmed with endoscopy. All patients were commenced on a twice-daily dose of intravenous PPI. This was changed to oral treatment after 2 days. Main outcome measures evaluated were resolution of symptoms on PPIs and failure of medical therapy. RESULTS There were five females and one male. Median age at diagnosis was 72 years (range, 30–90 years). Median duration of symptoms was 2 weeks (range, 1–5 weeks). Of the patients, five had a history of peptic ulcer disease. Complete resolution was achieved in 5 patients (83%). Median duration for resolution of symptoms was 9 days (range, 5–14 days). All patients were changed to oral PPIs after 2 days. One patient did not respond to oral therapy and required surgical intervention (pyloroplasty). Median follow-up was 26 months (range, 6–48 months). There was no recurrence of symptoms. All patients were discharged on low-dose PPI. CONCLUSIONS This study supports the view that proton pump inhibitors are a safe and feasible alternative to surgery in adult pyloric stenosis secondary to peptic ulcer disease.

scholarly journals Posterior Reversible Encephalopathy Syndrome: A Case of Hypercalcemia

2018 ◽  
Vol 31 (6) ◽  
pp. 338
Author(s):  
Ana Ponciano ◽  
Vera Vieira ◽  
José Leite ◽  
Célio Fernandes
Keyword(s):  
Renal Failure ◽  
Immunosuppressive Therapy ◽  
Mental Status ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Altered Mental Status ◽  
Normotensive Patient ◽  
Posterior Reversible Encephalopathy ◽  
Severe Hypercalcemia ◽  
Reversible Encephalopathy

Posterior reversible encephalopathy syndrome is an encephalopathy that can be clinically characterized by headache, altered mental status and/or seizures. Neuroimaging demonstrates usually reversible bilateral subcortical vasogenic occipital-parietal edema. Exact pathophysiology remains unclear but is commonly associated with hypertension, renal failure, sepsis and use of immunosuppressive therapy. Its development in the setting of severe hypercalcemia is extremely rare. The authors report a case of posterior reversible encephalopathy syndrome in a normotensive patient with severe hypercalcemia as the only identifiable cause.

scholarly journals Metabolic Alkalosis, Acute Renal Failure and Epileptic Seizures as Unusual Manifestations of an Upside-Down Stomach

2012 ◽  
Vol 6 (2) ◽  
pp. 452-458 ◽  
Author(s):  
Johannes Stephani ◽  
Martin Wagner ◽  
Thomas Breining ◽  
Jochen Klaus ◽  
Jan-Hendrik Niess
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Metabolic Alkalosis ◽  
Epileptic Seizures

scholarly journals Milk-Alkali Syndrome: An Unusual Cause of Acute Renal Failure

2003 ◽  
Vol 2 (2) ◽  
pp. 64-65
Author(s):  
Azhar Ahmad ◽  
◽  
Rodney Dathan ◽  
Keyword(s):  
Renal Failure ◽  
Calcium Carbonate ◽  
Metabolic Alkalosis ◽  
Case Reports ◽  
Symptomatic Treatment ◽  
Self Medication ◽  
H2 Receptor Antagonists ◽  
Over The Counter ◽  
Ulcer Disease

Milk–alkali syndrome is described as a triad of hypercalcaemia, metabolic alkalosis and renal impairment, resulting from the ingestion of calcium and absorbable alkali1. It was more common in the early part of the century when antacids were used for the symptomatic treatment of peptic ulcer disease. The use of antacids has since been overtaken by H2- receptor antagonists and proton pump inhibitors. More recently, there have been various case reports of milk-alkali syndrome due to the increasing use of calcium carbonate as part of the management of osteoporosis and chronic renal failure, and also the increasing availability of calcium carbonate ‘over the counter’. We describe a case of milk-alkali syndrome due to self-medication with calcium carbonate.

scholarly journals Probable Linezolid-Induced Pancytopenia

2005 ◽  
Vol 16 (5) ◽  
pp. 286-288 ◽  
Author(s):  
Nita Lakhani ◽  
William Thompson ◽  
Anne Marie Bombassaro
Keyword(s):  
Staphylococcus Aureus ◽  
Renal Failure ◽  
Acute Renal Failure ◽  
Cardiac Disease ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Deficiency Anemia ◽  
Patients At Risk ◽  
Baseline Values ◽  
Baseline Levels ◽  
Diabetic Foot Osteomyelitis

A 75-year-old male outpatient with cardiac disease, diabetes, chronic renal insufficiency and iron deficiency anemia was prescribed linezolid 600 mg twice daily for a methicillin-resistant Staphylococcus aureus diabetic foot osteomyelitis. After one week, his blood counts were consistent with baseline values. The patient failed to return for subsequent blood work. On day 26, he was admitted to hospital with acute renal failure secondary to dehydration, and was found to be pancytopenic (erythrocytes 2.5x1012/L, leukocytes 2.9x109/L, platelets 59x109/L, hemoglobin 71 g/L). The patient was transfused, and linezolid was discontinued. His blood counts improved over the week and remained at baseline two months later. The patient's decline in blood counts from baseline levels met previously established criteria for clinical significance. Application of the Naranjo scale indicated a probable relationship between pancytopenia and linezolid. Clinicians should be aware of this rare effect with linezolid, and prospectively identify patients at risk and emphasize weekly hematological monitoring.

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