Acute Angle Closure Glaucoma Occurring after Nebulized Bronchodilator Treatment with Ipratropium Bromide and Salbutamol

Abstract

1200 mg magnesium carbonate, 600 mg sodium bicarbonate daily as well as 2280 mg deglycyrrhizinized liquorice.In addition, 3.5 pints of milk daily would provide him with 2380 mg calcium, 230mg magnesium, but only 1.15 g (46 iu) calciferol daily'.The traditional explanation for hypercalcaemia in the milk-alkali syndrome is that absorbable alkali causes a decrease in renal calcium excretion in the face of a high calcium intake.Secondly, calcium excess increases renal tubular bicarbonate reabsorption both directly and indirectly through salt and water depletion, thus maintaining the alkalosis2.Our data show that other factors may contribute to the metabolic state.There was hypermagnesaemia due to renal failure as well as excessive intake.Intact PTH was detectable in serum, evidence that the normal suppression of the parathyroid glands by a high circulating calcium concentration was impaired.Lastly, serum 25 OH vitamin D was elevated despite a normal dietary intake.It is not clear how mineral and alkali intake can influence vitamin D status except in calcium depletion, where calcium intake has been shown to regulate 25 OH vitamin D metabolism3.Milk-alkali syndrome is rare but should be considered when hypercalcaemia presents as an emergency in order to prevent unnecessary treatment with hypocalcaemic agents.It should be remembered that Caved-S contains both alkali and magnesium in absorbable forms.