Antacid‐induced phosphate depletion syndrome presenting as nephrolithiasis

Abstract

A 29‐year‐old insulin‐dependent diabetic woman developed phosphate depletion, nephrolithiasis and bilateral ureteric obstruction due to antacid abuse. Unlike previous descriptions of chronic phosphate depletion, myalgia, weakness and bone pain were absent. Biochemical features included hypophosphataemia, hypercalciuria, hypophosphaturia, elevated plasma 1,25‐dihydroxyvitamin D and low plasma intact parathyroid hormone. These abnormalities were corrected when antacid ingestion was reduced and phosphate intake supplemented. Wepropose that phosphate depletion secondary to antacid abuse caused 1α‐hydroxylase activation and elevation of the plasma 1,25‐dihydroxyvitamin D level, leading to marked ..