Calcium-alkali syndrome — SCE Endocrinology MCQ

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HardCalcium/BoneCalcium-alkali syndromeSCE Endocrinology

A 56-year-old woman has thirst, polyuria and calcium 3.42 mmol/L after starting high-dose calcium carbonate for dyspepsia. PTH is suppressed, bicarbonate is 34 mmol/L and creatinine has risen from 70 to 165 micromol/L. What is the most likely diagnosis?

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Correct answer: D — Calcium-alkali syndrome

Calcium-alkali syndrome is best because hypercalcaemia with metabolic alkalosis and acute kidney injury after high calcium carbonate ingestion is calcium-alkali syndrome. The alternatives are less appropriate because primary and tertiary hyperparathyroidism would not suppress PTH; sarcoidosis causes calcitriol-mediated hypercalcaemia; FHH is mild and familial. The SCE teaching point is to integrate the clinical pattern, biochemistry and context rather than treating an isolated result.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/diabetes-and-other-endocrinal-nutritional-and-metabolic-conditions