Verburg F A J, van Zanten R A A, Brouwer R M L, Woittiez A J J, Veneman Th F
Twenteborg Ziekenhuis, afd. Interne Geneeskunde, Postbus 7600, 7600 SZ Almelo.
Ned Tijdschr Geneeskd. 2006 Jul 22;150(29):1624-7.
A 42-year-old man was transferred to the Emergency Department after his friends had found him unresponsive and confused in his room. He had been experiencing upper abdominal complaints for a period of several months. He had taken large amounts of a calcium carbonate/magnesium subcarbonate preparation (Rennie) and had consumed at least 3 litres of dairy products per day. His behaviour was reported as being more and more abnormal during the previous few weeks. On admission he was confused and agitated and had involuntary movements of his limbs. Laboratory investigation indicated a triple acid base disorder, i.e. metabolic alkalosis, respiratory alkalosis and high anion gap metabolic acidosis, with severe dehydration. The metabolic alkalosis was caused by the intake of large amounts of dairy and antacids: milk-alkali syndrome. The metabolic acidosis was the result of hypovolaemia and pre-renal renal failure and the respiratory alkalosis was caused by hyperventilation due to the organic psychosyndrome. The patient was treated with volume expansion by isotonic saline and the administration of potassium and he was sedated with low-dose midazolam, which led to a full respiratory compensation of the metabolic alkalosis. A few days following admission, both the plasma calcium concentration and renal function returned to normal; the acid-base disorder completely normalized and the organic psychosyndrome disappeared. On gastroduodenoscopy a gastric ulcer was found; biopsies revealed a signet ring cell adenocarcinoma of the stomach.
一名42岁男子在其朋友发现他在房间里无反应且神志不清后被送往急诊科。他上腹部不适已有数月。他服用了大量碳酸钙/次碳酸镁制剂（雷尼替丁），并且每天至少饮用3升乳制品。据报道，在过去几周里他的行为越来越异常。入院时，他神志不清且烦躁不安，四肢有不自主运动。实验室检查显示三重酸碱紊乱，即代谢性碱中毒、呼吸性碱中毒和高阴离子间隙代谢性酸中毒，并伴有严重脱水。代谢性碱中毒是由于摄入大量乳制品和抗酸剂所致：乳碱综合征。代谢性酸中毒是低血容量和肾前性肾衰竭的结果，呼吸性碱中毒是由器质性精神综合征导致的过度通气引起的。患者接受了等渗盐水扩容治疗并补充了钾，并用小剂量咪达唑仑镇静，这使得代谢性碱中毒得到了完全的呼吸代偿。入院几天后，血浆钙浓度和肾功能恢复正常；酸碱紊乱完全恢复正常，器质性精神综合征消失。在胃十二指肠镜检查中发现了胃溃疡；活检显示为胃印戒细胞腺癌。
