Table 1.

Different forms of the milk alkali syndromea

AcuteSubacute or IntermediateChronic
Other names
    toxemiaCope’s syndromeBurnett’s syndrome
    alkalosisalkalosis
Blood chemistry
    elevated calcium, BUN, and creatininesame as acutesame as acute
    normal or elevated phosphorus and CO2 contentsame as acutesame as acute
Symptoms
    frequent nausea, vomiting, anorexia, weakness, lethargy, mental changes (psychosis or encephalitis-like symptoms), headache, dizzinessfrequent nausea, vomiting, anorexia, mental changes, asthenia, muscle aching, polydipsia and polyuria, occasional conjunctivitisinfrequent nausea, vomiting, anorexia, occasional mental changes, asthenia, muscle aching, pruritus, polydipsia and polyuria
Other findings
    no band keratopathy or abnormal calcificationsoccasional band keratopathy; soft tissue calcifications absentband keratopathy and other abnormal calcifications, including nephrocalcinosis (histologic but not necessarily radiographic)
Response to withdrawal of milk and alkali
    rapid relief of symptoms, return of renal function to normal statusrapid relief of some symptoms, others clear gradually; gradual but marked improvement in renal function; normocalcemia but less rapid than in acute casesmuscle aching and pruritus clear slowly; little or no improvement in renal function; gradual normalization of blood calcium; some reduction of abnormal calcification
Circumstance in which the type is seen
    complication of treatment with milk and alkali, usually after approximately one week of such treatmentusually seen during therapy with milk and alkali used intermittently for yearsoccurs after long history of high milk or alkali intake or both
  • a Reprinted from reference (9), with permission. BUN, blood urea nitrogen.