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Rare complication of milk-alkali ingestion: severe pancreatitis and acute kidney injury in a chronic hypocalcaemic patient with DiGeorge’s syndrome
  1. Rajarshi Bhadra1,
  2. Fareeha Ahmed Khan1,
  3. Mona Soliman1,
  4. Meyappan Somasundaram1,
  5. Daniel V Iltchev2 and
  6. Keyvan Ravakhah1
  1. 1 Department of Internal Medicine, St Vincent Charity Medical Center, Cleveland, Ohio, USA
  2. 2 Department of Pulmonary and Critical Care Medicine, St Vincent Charity Medical Center, Cleveland, Ohio, USA
  1. Correspondence to Dr Rajarshi Bhadra, drrajarshibhadra{at}


Injudicious use of over-the-counter calcium supplements has resulted in increased incidences of hypercalcaemia and related complications. We present a case of acute pancreatitis in a chronic hypocalcaemic patient of DiGeorge’s syndrome. The patient came into the ED with sepsis syndrome, right upper quadrant and epigastric pain and no obvious source of infection. Lab results and imaging were indicative of acute pancreatitis. There was severe renal dysfunction. The patient needed haemodialysis and had a prolonged stay in intensive care. The medical history was negative for biliary duct pathology or alcohol use. The patient had vomiting and diarrhoea in the nursing home for about a week, but she continued to receive her regular medications that included the calcium supplements and thiazide diuretics. It is likely that a complex interplay between calcium supplementation, dehydration and thiazide diuretics resulted in the development of acute pancreatitis and severe renal dysfunction in a chronic hypocalcaemic patient.

  • gastrointestinal system
  • renal system
  • pituitary disorders
  • pancreas and biliary tract
  • adult intensive care

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  • MS and MS contributed equally.

  • Contributors RB was involved in planning, conducting, reporting, conception and design, acquisition of data and interpretation of data. He was also directly involved in patient care right from admitting the patient. FAK was the intern taking care of the patient and was involved in helping in the process of literature review. DI was the pulmonary and critical care consultant who was the prime person who took critical decisions in caring for the patient and with whom the patient is currently following-up after her hospital discharge. Overall, the literature review and managing the final texture of the article can be attributed to his credit. KR has been involved in the overall review, correction of the final manuscript, incorporating valuable inputs as regards patient care experience and in final drafting the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.