Betel Nut Induced Milk-Alkali Syndrome-Case Report

The betel nut is also called ”Taiwanese chewing gum”. The most harmful side effect of habitual chewing of betel nuts is oral cancer. Milk-alkali syndrome, characterized by the triad of metabolic alkalosis, hypercalcemia and renal failure, is a less known effect of betel nut chewing. We describe three patients who came to the emergency department with complaints of dizziness, myalgia, poor appetite, malaise, body weight loss, constipation and decreased urine output. They all chewed white lime betel nuts wrapped in the leaves of Piper betle with ground oyster shell paste containing calcium carbonate. They had consumed about 30-60 nuts daily for decades to increase alertness and work capacity. Physical examinations revealed obvious dehydration. Laboratory examinations revealed metabolic alkalosis, hypercalcemia, and impaired renal function or renal failure. Serum intact-parathyroid hormone (i-PTH) and activated vitamin D (1, 25(OH)2D3) levels were decreased in response to hypercalcemia. All metabolic abnormalities were corrected within 10 days after supportive treatment and decreased betel nut ingestion during hospitalization, except for impaired renal function in one patient who had chewed betel nuts for more than 30 years. Since betel nut chewing is common in Taiwan, clinical physicians should be aware of this syndrome.

並列關鍵字

betel nut ； hypercalcemia ； milk-alkali syndrome

國際替代計量

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