Excess use of Tums causing hypercalcemia and encephalopathy in pregnancy

Background: This is a case report of a unique presentation of hypercalcemia leading to encephalopathy in pregnancy. Understanding risks with over-the- counter antacids may improve the wellbeing of patients and improve counseling. Case Presentation: 29yo G2P1 at 36w admitted for influenza A with pneumonia and dehydration. • Admitted for symptom management • Patient ingested “handfuls of Tums” for heartburn • Calcium level of 14.1mg/dL (normal 8.4 - 10.2) • Patient encouraged to discontinue Tums and discharged Patient was re-admitted 2 days later with weakness, nausea, and altered mental status due to ongoing ingestion of “handfuls of Tums” • Calcium 18.3 mg/dL (severe hypercalcemia) • Cesarean section performed due to worsening symptoms and severe preeclampsia. • Admitted to ICU postop, calcium normalized but symptoms did not improve. MRI of the brain revealed multifocal lesions consistent with encephalopathy believed secondary to hypercalcemia. Diagnosed with hypercalcemia alkaline syndrome, encephalopathy, and acute pancreatitis due to Tums overdose. The patient was transferred to rehab due to difficulty speaking, walking, and eating. Discussion: - Milk-alkali syndrome manifests through the triad of symptoms of elevated calcium levels, metabolic alkalosis, and acute kidney injury.1 • Tums are a calcium salt which work by neutralizing gastric acidity, inhibiting pepsin’s proteolytic activity, and increase lower esophageal sphincter tone. • Tums are pregnancy category C – only use if the benefit outweighs the risk after discussion with the patient. • Dosing for heartburn in adults ranges from 500- 1000 mg, not to exceed 7 g daily. This patient was eating “handfuls” of tums multiple times per day. The metabolic alkalosis that ensues from hypercalcemia can lead to CNS manifestations including coma and altered mental status.