Milk-Alkali Syndrome: A Century-old Cause of Hypercalcemia Requires the Addition of Venous Blood Gas in Hypercalcemia Workup.

The Milk-Alkali syndrome (MAS) is identified by the triad of high serum levels of calcium, metabolic alkalosis, and acute kidney injury, usually caused by consuming excessive amounts of calcium and absorbable alkali. If not treated promptly, the syndrome can result in rapid hypercalcemia, acute renal failure, and metastatic calcification. Notably, an increasing number of cases of MAS have been observed, potentially due to the rampant use of calcium-based over-the-counter supplements for the prevention and treatment of osteoporosis in postmenopausal women. Herein, we report a case of severe hypercalcemia due to prolonged intake of calcium carbonate supplements in the absence of any alkali. The case report highlights the importance of including venous blood gas (VBG) analysis as a part of the workup for hypercalcemia, as metabolic alkalosis can help clinch the diagnosis of MAS in the setting of severe hypercalcemia. How to cite this article: Sahu U, Trivedi T, Gupta R. Milk-Alkali Syndrome: A Century-old Cause of Hypercalcemia Requires the Addition of Venous Blood Gas in Hypercalcemia Workup. J Assoc Physicians India 2023;71(9):104-105.

Clinical Study of Cardiac Autonomic Dysfunction and QT Dispersion in Newly Diagnosed HIV/AIDS Patients and its Correlation with CD(4) Count.

Objectives: To evaluate the cardiac autonomic dysfunction and QT dispersion in newly diagnosed HIV/AIDS patients and to correlate the cardiac autonomic dysfunction with CD4 count. Methods: It was a prospective study conducted on 50 patients (25 HIV positive without AIDS and 25 HIV with AIDS) and 50 healthy controls in the department of General Medicine, JLN Hospital, Ajmer. Autonomic function was assessed by Ewing battery of autonomic function tests and QT dispersion was calculated. Results: In the present study 16% of HIV positive with AIDS had abnormal autonomic dysfunction and 4% of HIV positive without AIDS had abnormal autonomic dysfunction. 48% of patients in AIDS group and 16% of patients in HIV positive without AIDS group showed abnormal QT dispersion. There was no statistically significant correlation with CD4 count. Conclusion: Apart from opportunistic infections, autonomic dysfunction itself can contribute to mortality and morbidity in HIV/AIDS patients. Our study showed that cardiac autonomic dysfunction is a common and relevant clinical problem. It is significantly affected in both HIV positive without AIDS and HIV positive with AIDS groups. QT dispersion is a sensitive predictor of cardiac dysautonomia. But there is no statistically significant correlation with CD4 count.

Infantile (Preductal) Coarctation of Aorta Presenting as Cerebellar Infarct - A Rare Presentation.

Coarctation of aorta is a common congenital heart defect. The diagnosis may be missed unless a highindex of suspicion is maintained, and is often delayed until the patient develops congestive heart failure (CHF), (common in infants) or hypertension (common in older children). It seldom goes undiagnosed till adulthood and frequently leads to complications as a result of long-standing high blood pressure. Intracranial haemorrhage, premature coronary artery disease, aortic aneurysms and rupture have all been reported. But it is rare to see a patient with preductal (infantile) coarctation survive childhood and presents with an infarct in adulthood. We herein present a case report of a young woman who came with vomiting and giddiness and was diagnosed as a case of cerebellar infarct due to a concealed preductal (infantile) coarctation of aorta.