Nicotine-substitute gum-induced milk alkali syndrome: a look at unexpected sources of calcium.

OBJECTIVE: This report describes a 64-year-old woman with recurrent hypercalcemia. Her laboratory evaluation was consistent with milk-alkali syndrome. It was eventually discovered that the source of the excessive calcium consumption was nicotine-replacement chewing gum and carbonated water.

METHODS: An extensive literature search was performed to see if milk-alkali syndrome due to nicotine-replacement gum and carbonated water has been previously reported.

RESULTS: No prior report describing the association of milk alkali syndrome with nicotine-replacement gum and carbonated water was found.

CONCLUSION: We present a unique case of milk-alkali syndrome due to nicotine-replacement gum and carbonated water. It serves as a lesson to evaluate other sources besides calcium supplements as the cause of excessive calcium intake.