Olschewski P, Nordmeyer J P, Scholten T
Medizinische Klinik, Allgemeinen Krankenhauses für die Stadt Hagen, Lehrstuhl Innere Medizin I, Universität Witten-Herdecke.
Dtsch Med Wochenschr. 1996 Aug 16;121(33):1015-8. doi: 10.1055/s-2008-1043100.
A 54-year-old man was hospitalised because hypercalcaemia and associated renal failure were suspected. He had a history suggesting gastric ulcer, with nonspecific back and shoulder pain and spontaneously passed kidney stone. On admission the patient reported reduction in physical fitness, fatigue, headache and nausea without vomiting. Physical examination was unremarkable except for pain on pressure over the thoracic and lumbar vertebrae.
Hypercalcaemia of 3.9 mmol/l was found while parathormone was low. Serum creatinine concentration was 2.8 mg/dl. Malignancy was excluded after extensive tests. A florid gastric ulcer was demonstrated, together with Helicobacter pylori infection. Computed tomography revealed stippled calcifications in the kidneys.
Renal function markedly improved, the hypercalcaemia disappeared and the parathormone level rose within four days of the administration of sodium chloride (2.51 daily of a 0.9% solution) and of furosemide (40 mg daily). Repeat questioning of the patient revealed that because of stomach pains he had for four years been taking up to 6 g calcium carbonate daily in the form of a prescription-free antacid. He was thereupon treated for a milk-alkali syndrome. Calcium concentration became normal, while renal function has remained slightly impaired a year later. The ulcer has healed without recurrence on eradication of the Helicobacter pylori infection with amoxicillin and omeprazole.
The danger of some "over the counter" prescription-free medications should not be underestimated and patients should be routinely questioned about them. Absorbable antacids should no longer be taken in the treatment of peptic complaints now that effective antacids, H2-receptor antagonists and proton-pump inhibitors have become available.
一名54岁男性因怀疑高钙血症及相关肾衰竭而入院。他有胃溃疡病史，伴有非特异性的背部和肩部疼痛，曾自发排出肾结石。入院时，患者自述体能下降、疲劳、头痛和恶心，但无呕吐。体格检查无异常，仅胸腰椎压痛。
血钙浓度为3.9 mmol/l，甲状旁腺激素水平较低。血清肌酐浓度为2.8 mg/dl。经过广泛检查排除了恶性肿瘤。发现有明显的胃溃疡，同时伴有幽门螺杆菌感染。计算机断层扫描显示双肾有散在的钙化点。
在给予氯化钠（每日2.51升0.9%溶液）和呋塞米（每日40毫克）后四天内，肾功能显著改善，高钙血症消失，甲状旁腺激素水平上升。再次询问患者得知，因胃痛他已连续四年每天服用高达6克碳酸钙，以非处方抗酸剂的形式。于是对他进行了乳-碱综合征的治疗。血钙浓度恢复正常，而一年后肾功能仍有轻微损害。通过阿莫西林和奥美拉唑根除幽门螺杆菌感染后，溃疡已愈合且未复发。
一些非处方药物的危险性不应被低估，应常规询问患者服用情况。鉴于现在已有有效的抗酸剂、H2受体拮抗剂和质子泵抑制剂，治疗消化性疾病时不应再服用可吸收性抗酸剂。
