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Diagnosis:
Prior to an official diagnosis of milk-alkali syndrome, other causes of hypercalcemia must be ruled out. Other causes of hypercalcemia can include elevated vitamin D levels, hyperthyroidism, and hyperparathyroidism.
Physical Examination:
Symptoms such as vertigo, confusion, apathy, nausea and vomiting, anorexia, tremors, psychosis, myalgia, polyuria, abnormal calcifications such as renal calcifications, and pruitus could be observed in people.
Lab work:
Lab work must be done to diagnose milk-alkali syndrome. Lab workup includes serum calcium levels, parathyroid hormone (PTH), phosphorus, creatinine, blood urea nitrogen (BUN), magnesium, and vitamin D levels. primary hyperparathyroidism has to be excluded. Diagnosis is made by looking at past medical history and laboratory studies.
- Serum calcium levels: high serum calcium levels.
- PTH: low serum PTH levels are indicative of MAS. Low serum PTH levels also exclude primary hyperthyroidism.
- Phosphorus: low serum phosphorus levels due to low PTH.
- Creatinine and BUN: high levels can indicate severity of renal damage.
- Magnesium: serum magnesium levels are low as hypercalcemia inhibits mg^2+ reabsorption in the renal tubules.
- Vitamin D levels: low vitamin D levels are found. Normal vitamin D levels eliminate primary hypercalcemia.ECG intervals
Electrocardiograms (ECG):
An ECG can also be used to diagnose MAS. The following findings related to hypercalcemia could appear on an ECG:
- Short QT interval: most commonly seen as short OoT or OaT changes.
- Prolongation of PR and QRS intervals.
- Increased Amplitude of QRS complex.
- Osborn wave
- Short ST segment.
Radiology:
Chest x-rays can help exclude any malignancy or sarcoidosis when evaluating for hypercalcemia.
[1] Milk Alkali Syndrome and the Dynamics of Calcium Homeostasis
- ^ Felsenfeld, Arnold J.; Levine, Barton S. (2006-07-01). "Milk Alkali Syndrome and the Dynamics of Calcium Homeostasis". Clinical Journal of the American Society of Nephrology. 1 (4): 641–654.