Patients of Burnett’s syndrome suffer from an excessive supply of calcium and alkalis, which often goes back to appropriate dietary supplements. It is also known as milk-alkali syndrome. In addition to calcium deposits in the conjunctiva and corneas, symptomatic ataxia, nausea and vomiting can occur.
What is Burnett Syndrome?
Burnett’s syndrome is also known as milk-alkali syndrome. This is a disorder of calcium metabolism, which is related to an excess of calcium and easy-to-absorb alkalis. In most cases, the syndrome occurs as a result of other medical conditions being treated. The namesake of the metabolic disorder is the American doctor Charles Hoyt Burnett.
At the beginning of the 20th century, doctors sometimes treated stomach ulcers by giving milk, alkali powder and cream every hour. This milk-alkali treatment relieved the gastric ulcer symptoms. However, the therapy was often associated with serious side effects, including kidney failure. Burnett’s syndrome, or Milch-Allkali syndrome, occurred most frequently in connection with this gastric ulcer treatment. As soon as there were better therapies for gastric ulcers, the incidence of the syndrome declined. In the meantime, Burnett’s syndrome is becoming 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 through absorption in the stomach and intestines. In Burnett’s syndrome, the calcium level in the serum in particular is increased. This increase is due to an increased absorption of calcium or in the gastrointestinal tract and is therefore mostly related to the excessive consumption of calcium-containing or alkaline foods.
This excessive consumption occurred in the 20th century in particular 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 contain the disease. The syndrome also is favored by the intake of Vitamin D.
Symptoms, ailments & signs
The most common symptoms of Burnett’s syndrome are nausea, vomiting, and dizziness. Sometimes there is also an ataxia, i.e. a gait disorder. In addition to increased serum calcium, i.e. hypercalcemia, calcinosis can also occur. In calcinosis, the body may store the excess calcium in the conjunctiva, cornea or renal tubules. Storage in the kidneys can lead to renal failure.
The one in the eyes is often visible at first glance and often affects the fissure of the eyelid in particular, where it can trigger bankeratitis. Sometimes, with pronounced calcinosis, neurological symptoms such as depression, confusion, and persistent fatigue also occur. The more severe the case, the more severe these disturbances of consciousness can also be. In extreme cases, the neurological symptoms can range up to comatose symptoms.
Diagnosis & course
The anamnesis gives the doctor the first clues about Burnett’s syndrome. As a rule, the anamnestic shows the intake of dietary calcium or alkali salts. An elevated calcium level in the blood suggests Burnett’s syndrome. Hardly any calcium can be found in the urine because hypercalcemia narrows the blood vessels in the kidneys, preventing them from being excreted.
An increased level of parathyroid hormone and metabolic alkalosis with increased phosphate levels also speak for the syndrome. In the modern form, however, the phosphate level remains unchanged more and more often. The course depends on where and how much calcium has been stored. In the past, deaths from kidney failure were sometimes reported in connection with the syndrome. Today, however, fatal consequences are as good as impossible.
When should you go to the doctor?
As a rule, Burnett’s syndrome does not heal itself if the person concerned does not change their diet. Because of this, medical evaluation and treatment is necessary to avoid further complications from the syndrome. A doctor should be seen if the person has been vomiting or feeling sick for a long time for no particular reason.
Dizziness and gait disorders are also relatively common and can indicate the disease. Renal insufficiency also occurs without treatment. Therefore, if kidney problems occur, a doctor must be consulted immediately. Confusion or depression are also among the symptoms of Burnett’s syndrome and should be examined if they persist over a long period of time. In some cases, the sufferer may also lose consciousness or fall into a coma with this condition.
The first exam is usually done by a general practitioner. In emergencies, however, you can also go to the hospital or call an emergency doctor.
Treatment & Therapy
The first step in treating patients with Burnett’s syndrome is to stop calcium intake immediately. In most cases, the doctor combines this measure with the administration of saline solutions. This isotonic solution is usually administered intravenously. The aim of this therapeutic measure is the hydration and support of the kidneys.
The saline solution is intended to inhibit passive tubular reabsorption in the tubular system of the kidneys. The tubules of the kidneys take up many of the filtered out substances in the course of reabsorption. In particular, an increased blood phosphate level can be compensated for by administering saline solution. The liquid saturates the reabsorption. The excess phosphate and calcium are excreted until the level in the blood has normalized. Serum calcium is permanently monitored during inpatient treatment.
If Burnett’s syndrome is only mild, treatment is usually on an outpatient basis and close monitoring is not required. Some patients with Burnett’s syndrome are also given a diuretic diuretic that is supposed to drive the kidneys. However, too high a dose of this drug can worsen the condition and exacerbate the calcinosis. Therefore, this form of treatment mostly refers to inpatients who can be monitored for safety.
Outlook & forecast
In most cases, Burnett’s syndrome can be treated relatively easily and well. If the person concerned does not seek treatment despite the appearance of symptoms, Burnett’s syndrome can lead to serious consequences and in the worst case to death of the person concerned. However, this only occurs with prolonged consumption of supplements.
The syndrome itself is treated by the patient foregoing the supplements. There are no further complaints and the symptoms subside over time. In acute emergencies, the state of health can be improved by taking calcium. The person affected also receives various injections to relieve the kidneys.
Irreversible damage usually only occurs due to Burnett’s syndrome if there is no treatment and the calcium is consumed in large quantities over a very long period of time. Ordinary food cannot cause the syndrome to occur. The further course or the severity of the symptoms also depend heavily on the amount of calcium actually consumed. In general, however, the disease can be treated very well.
Prevention
To prevent Burnett’s syndrome, the daily calcium intake should not exceed a dose between 1200 and 1500 milligrams. Basic and calcium-containing food supplements should always be handled carefully. Burnett syndrome is unlikely to result from actual food.
Aftercare
In the first time after an occurrence, a check can be useful. However, this only applies to serious illnesses. Since in the worst case there is a risk of kidney failure, adequate laboratory tests of the blood should take place. Determination of serum calcium and serum phosphate is particularly useful. The occurrence as a result of other treatments, such as gastric ulcers, is a special case.
If the previous treatment is continued, those affected will not be able to avoid follow-up care. As long as illnesses favor the occurrence, even close-knit long-term treatment is advisable. Regular appointments should be made with a general practitioner so as not to risk kidney failure. Most of the time, however, the disease is mild. Then medical follow-up is not necessarily advisable.
Statistically speaking, complications are not likely to be expected. Rather, the obligation to take preventive action takes effect. Daily calcium intake shouldn’t exceed 1,500 milligrams. Calcium-containing foods should be avoided as part of the daily diet.
There is no danger with a normal lifestyle. A renewed illness is unlikely after mild and moderate symptoms have subsided, which is why one can refrain from continuous follow-up care. If the known symptoms recur, patients should definitely consult a doctor.
You can do that yourself
Burnett’s syndrome can lead to kidney failure in severe cases, which is why patients should always consult a doctor promptly.
The disease particularly often affects women who take high-dose calcium supplements for the purpose of prophylaxis or therapy for osteoporosis. If this group of people shows symptoms of Burnett’s syndrome, in particular nausea, dizziness, vomiting and occasionally a disturbance in walking (ataxia) in the early stages, medical help must be sought promptly.
The attending physician must be informed about the intake of calcium. The most important step in treatment is usually the discontinuation of these preparations. In addition, the calcium intake generally has to be 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, yoghurt, quark or whey-based diet shakes must then be avoided. If you don’t want to do without these foods completely, you can switch to herbal substitutes. Cow milk in particular can be easily replaced by soy or almond drinks.
Plant-based alternatives are also already available for cheese and yoghurt. While calcium is rarely found naturally in these products, it is sometimes added. Those affected should therefore pay attention to notes such as “with calcium” and study the ingredients. If you are unsure, you can get competent advice from organic supermarkets and health food stores.
