Abstract: FR-PO1073
Detailed History Unravels the Mystery: An Unusual Case of Almond Breeze Hypercalcemia
Session Information
- Kidney Nutrition and Metabolism
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Health Maintenance, Nutrition, and Metabolism
- 1500 Health Maintenance, Nutrition, and Metabolism
Authors
- Phillips, Johnathon, Ochsner Health, New Orleans, Louisiana, United States
- Kanduri, Swetha Rani, Ochsner Health, New Orleans, Louisiana, United States
- Velez, Juan Carlos Q., Ochsner Health, New Orleans, Louisiana, United States
- Kovvuru, Karthik, Ochsner Health, New Orleans, Louisiana, United States
Introduction
Serological tests play a vital role in teasing out the etiology of hypercalcemia. However, obtaining a thorough history is required to unravel a mystery. Herein, we report an unusual case of a patient with chronic kidney disease (CKD) presenting with hypercalcemia and acute kidney injury (AKI) due to consumption of excess almond breeze milk.
Case Description
A 66-year-old male with uncontrolled type 2 diabetes mellitus and hypertension was admitted to the hospital due to severe hypercalcemia [serum calcium (sCa) 15.4 mg/L] and acute on chronic kidney injury (serum creatinine 3.7 mg/dL, baseline of 1.5-1.8 mg/dL). Upon admission, he was drowsy but arousable. According to his wife, he was not in his usual state of health for over a week. Denied intake of over-the-counter medications, vitamin supplements. Additional laboratory data included blood urea nitrogen (BUN) 51 mg/dL, bicarbonate 23 mmol/L, albumin 3.8 g/dL, ionized calcium 1.5 mmol/L. Serological work up revealed suppressed parathyroid hormone (PTH) of 14.5 pg/mL, normal PTH-related peptide of 1.0 pmol/L, vitamin D 29 nm/L, 1,25-dihydroxy vitamin D 10 pg/mL, and a serum protein electrophoresis negative for monoclonal bands. Renal ultrasound unremarkable. Upon further inquiry, wife reported habitual drinking of a gallon of milk every day for years and a recent switch to sugar-free almond breeze milk 3 weeks prior to index hospital admission, in an attempt to control his blood glucose levels. Upon review of the product label of almond breeze milk, 1 cup contains 450 mg of calcium which corresponds to 7 g of calcium/gallon of almond breeze, which is 50% more calcium than regular milk. The patient was treated with IV normal saline and calcitonin. sCa improved to 10.2 mg/dL and patient was discharged home and instructed to avoid almond breeze milk. sCa remained within normal limits at a follow-up clinic visit.
Discussion
With increasing availability of highly fortified drinks and supplements, patients with CKD are at risk of ingesting higher than recommended dosages potentially leading to ill effects. In addition to obtaining a thorough history, advising patients with CKD to pay attention to product labels and discuss them with physicians is highly encouraged.