Q:

A 26 year old man is referred for gastroscopy because of a history of several months of dyspepsia. He has routine bloods checked and is found to have a serum calcium level=3.2mmol/l What is the most likely cause of his hypercalcemia?

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A 26 year old man is referred for gastroscopy because of a history of several months of dyspepsia. He has routine bloods checked and is found to have a serum calcium level=3.2mmol/l with a venous bicarbonate level of 33mmol/l. Renal and LFT are both normal. CXR is normal. What is the most likely cause of his hypercalcemia?


  1. Melanoma
  2. Metastatic malignancy
  3. Milk alkali syndrome
  4. Primary hyperparathyroidism
  5. Sarcoidosis

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The key is C. Milk alkali syndrome. [In medicine, milk-alkali syndrome is characterized by high blood calcium caused by taking in too much calcium and absorbable alkali; common sources of calcium and alkali are dietary supplements taken to prevent osteoporosis and antacids. If untreated, milk-alkali syndrome may lead to kidney failure or death].

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