Burnett syndrome patients suffer from an excessive supply of calcium and alkalis, often due to appropriate dietary supplements. It is also known as milk-alkali syndrome. In addition to calcium deposits in the conjunctiva and corneas, symptomatic symptoms may include ataxia, nausea, and vomiting.
What is Burnett syndrome?
Burnett syndrome is also known as milk alkali syndrome. It is a disorder of calcium metabolism associated with an excess of calcium and easily absorbed alkalis. The syndrome occurs in most cases as a result of treatment of other diseases. The eponym of the metabolic disorder is the American physician Charles Hoyt Burnett. At the beginning of the 20th century, physicians sometimes treated stomach ulcers by giving milk, alkali powder and cream every hour. This milk-alkali treatment improved peptic ulcer symptoms. However, the therapy was often associated with serious side effects, including renal failure. Burnett’s or milk alkali syndrome occurred most frequently in association with this peptic ulcer treatment. Once better treatment options for peptic ulcers became available, the incidence of the syndrome declined. However, Burnett syndrome has since become more common again.
Causes
During digestion, the gastrointestinal tract absorbs alkalis via bicarbonates and calcium via foods such as milk. It makes these substances available to the organism via absorption in the stomach and intestines. In Burnett’s syndrome, the serum calcium level in particular is elevated. This elevation is due to increased absorption of calcium or in the gastrointestinal tract and so is usually related to excessive consumption of calcium-containing or alkaline foods. This excessive consumption occurred in the 20th century, especially in the context of gastric ulcer therapy. In the 21st century, the scenario often affects women with osteoporosis who consume more than the recommended 1200 to 1500 milligrams of calcium to prevent or control the disease. The syndrome is also favored by vitamin D intake.
Symptoms, complaints, and signs
The most common symptoms of Burnett syndrome are nausea, vomiting, and dizziness. Sometimes ataxia, or gait disturbance, also presents. In addition to elevated serum calcium, or hypercalcemia, calcinosis may also occur. In calcinosis, the excess calcium may be stored by the body in the conjunctiva, cornea, or renal tubules. Storage in the kidneys can lead to renal insufficiency. The one in the eyes is often visible at first sight and often affects mainly the palpebral fissure, where it can cause bankeratitis. Sometimes, with pronounced calcinosis, there are additional neurological symptoms such as depression, confusion and persistent fatigue. The more severe the case, the more severe these disturbances of consciousness may also be. In extreme cases, neurologic symptoms can thus extend to comatose phenomena.
Diagnosis and course
The medical history provides the physician with the first clues to Burnett syndrome. Usually, anamnesis reveals the ingestion of dietary supplemental calcium or alkaline salts. In the blood, an elevated calcium level is indicative of Burnett’s syndrome. Hardly any calcium can be detected in the urine because hypercalcemia constricts the blood vessels of the kidneys, preventing them from excreting. Elevated levels of parathyroid hormone and metabolic alkalosis with elevated phosphate levels are also indicative of the syndrome. In the modern form, however, the phosphate level increasingly remains unchanged. The course depends on where and how much calcium has been stored. In the past, deaths due to kidney failure were sometimes reported in connection with the syndrome. Today, however, fatal consequences have been virtually ruled out.
When should you go to the doctor?
As a rule, Burnett syndrome does not heal itself if the affected person does not change his diet. For this reason, medical examination and treatment are necessary to prevent further complications from the syndrome. A doctor should be consulted if the affected person suffers from vomiting or nausea for a long period of time and without any particular reason. Dizziness and gait disturbances are also relatively common and may indicate the presence of the disease.Likewise, renal insufficiency occurs without treatment. Therefore, if kidney complaints also occur, a doctor must be consulted immediately. Confusion or depression are also among the symptoms of Burnett’s syndrome and should be investigated if they persist over a long period of time. In some cases, the affected person may also lose consciousness or go into a coma with this condition. The initial examination is usually performed by a general practitioner. However, in emergencies, the hospital may be visited or an emergency physician may be called.
Treatment and therapy
The first step in treating patients with Burnett syndrome is to stop calcium intake immediately. In most cases, the physician combines this measure with the administration of saline solutions. The administration of this isotonic solution usually takes place intravenously. The goal of this therapeutic measure is to hydrate and support the kidneys. The saline solution is intended to inhibit passive tubular reabsorption in the tubular system of the kidneys. The tubules of the kidneys reabsorb many filtered-out substances in the course of reabsorption. Especially an elevated blood phosphate level can be compensated by the administration of saline solution. This is because the fluid saturates the reabsorption. The excess phosphate and calcium are thus excreted until the level in the blood is normalized. Serum calcium is permanently monitored during inpatient treatment. If only a mild form of Burnett’s syndrome is present, treatment usually takes place on an outpatient basis and close monitoring is not required. In some cases, Burnett syndrome patients are also given a diuretic loop diuretic to drive the kidneys. However, too high a dosage of this drug can also cause deterioration and exacerbate calcinosis. Therefore, this form of treatment usually refers to hospitalized patients who can be monitored for safety.
Outlook and prognosis
In most cases, Burnett syndrome can be treated relatively easily and well. If the affected person does not seek treatment despite the onset of symptoms, Burnett syndrome can lead to severe consequences and, in the worst case, death of the affected person. However, this case occurs only in the case of very prolonged consumption of supplements. The syndrome itself is treated by the patient abstaining from the supplements. In this case, no further symptoms occur and the symptoms subside with time. In acute emergencies, the health condition can be improved by taking calcium. Likewise, the affected person receives various injections to relieve the kidneys. Irreversible damage from Burnett’s syndrome usually occurs only when no treatment is given and calcium is taken in high amounts over a very long period of time. In this case, the syndrome cannot occur from an ordinary diet. The further course or the severity of the symptoms also strongly depends on the actual amount of calcium taken. In general, however, the disease can be treated very well.
Prevention
To prevent Burnett’s syndrome, daily calcium intake should not exceed a dose between 1200 and 1500 milligrams. Alkaline and calcium supplements should always be used with caution. Burnett syndrome tends not to set in through actual food.
Aftercare
In the first period after an occurrence, control may be useful. However, this applies exclusively to severe diseases. Since kidney failure is imminent in the worst case, sufficient laboratory examinations of the blood should take place. Especially a determination of serum calcium and serum phosphate is useful. A special case is the occurrence as a consequence of other treatments such as gastric ulcers. If the previous treatment is continued, those affected cannot avoid follow-up care. As long as diseases favor the occurrence, even a close-meshed permanent treatment is advisable. Regular appointments should be made with a general practitioner to avoid the risk of kidney failure. In most cases, however, the disease is mild. In this case, medical follow-up is not necessarily advisable. Statistically, complications are not to be expected. Rather, the obligation to take one’s own preventive measures then takes effect. The daily calcium intake should not exceed 1,500 milligrams.Foods containing calcium are to be avoided as part of the everyday diet. There is no danger with a normal lifestyle. A recurrence of the disease is unlikely after mild and moderately severe symptoms have subsided, which is why continuous follow-up care is not necessary. If the known symptoms recur, patients should definitely consult a physician.
What you can do yourself
Burnett syndrome can lead to kidney failure in severe cases, so patients should always seek medical attention promptly. The disease particularly often affects women who take high-dose calcium supplements for the purpose of prophylaxis or therapy of osteoporosis. If this group of people shows symptoms of Burnett’s syndrome, which in the early stages include in particular nausea, dizziness, vomiting and occasionally also a disturbance in walking (ataxia), medical help must be sought promptly. It is essential to inform the treating physician about the intake of calcium. The most important treatment step is usually to discontinue these supplements. In addition, calcium intake must usually be generally reduced for a certain period of time. In many cases, those affected are forced to change their diet, at least temporarily. Calcium-rich foods such as cow’s milk, cheese, yogurt, quark or whey-based diet shakes must then be avoided. Who does not want to do completely without these foods, can switch to vegetable substitute products. Cow’s milk in particular can be replaced very well by soy or almond drinks. Plant-based alternatives are also already available for cheese and yogurt. While calcium hardly occurs naturally in these products, it is sometimes added. Those affected should therefore look out for indications such as “with calcium” and study the ingredients. Those who are unsure can seek competent advice in organic supermarkets and health food stores.
