Hypercalcemia and Upper GI Symptoms

  • Dasha Moza McGill University
  • Kaberi Dasgupta McGill University
  • Stella Daskalopoulou McGill University
Keywords: Hypercalcemia, peptic ulcer disease


Hypercalcemia is a common clinical presentation encountered in day to day practice. The most common causes of hypercalcemia have been shown to be primary hyperparathyroidism and hypercalcemia of malignancy accounting for around 90% of all cases. We present the case of a 78 year old male admitted to hospital with delirium and an uncommon cause of hypercalcemia, milk alkali syndrome (MAS) in the context of Peptic ulcer disease (PUD). MAS, caused by excessive intake of calcium based antacids, was first identified in the 1920’s when the Sippy regimen, consisting of milk or cream and calcium salts was used to treat peptic ulcers. With the advent of proton pump inhibitors and histamine-2 blockers, it had become a rare cause of hypercalcemia responsible for <1% of the cases. However, there has been a re-emergence of MAS due to the increased use of calcium supplements for osteoporosis prevention and over-the-counter preparations for dyspepsia. Interestingly, apart from the well-known classic symptoms of hypercalcemia, chronic hypercalcemia also increases gastric acid production and worsens PUD which in this case, could likely have lead to increased calcium–based antacid ingestion, worsening the hypercalcemia and creating a vicious cycle. This case report explores the physiology of the connection between hypercalcemia and PUD and emphasizes the need to keep MAS on the differential diagnosis for hypercalcemia.

Author Biographies

Dasha Moza, McGill University

Division of Internal Medicine, Department of Medicine

Post Graduate training year 3

Kaberi Dasgupta, McGill University

Division of Internal Medicine and Clinical Epidemiology, Department of Medicine

Associate Professor and Clinician Scientist, MD, MSc

Stella Daskalopoulou, McGill University

Division of Internal Medicine, Department of Medicine, 

Associate Professor of Medicine, MD, MSc, PhD


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How to Cite
Moza, D., Dasgupta, K., & Daskalopoulou, S. (2018). Hypercalcemia and Upper GI Symptoms. Canadian Journal of General Internal Medicine, 13(2). https://doi.org/10.22374/cjgim.v13i2.224
Case Report