Although Burtis et al. (1994) identified what could be defined as LOAELs for hypercalciuria, 1,685 mg (42.1 mmol)/day in men and 866 mg (21.6 mmol)/day in women, these values are not considered as appropriate for use as the LOAEL for healthy adults as they were based on patients with renal stones. However, they support for the need for conservative estimates of the Tolerable Upper Intake Level (UL).

Uncertainty Assessment. An uncertainty factor (UF) of 2 is recommended to take into account the potential for increased risk of high calcium intake based on the following: (1) 12 percent of the American population is estimated to have renal stones, (2) hypercalciuria has been shown to occur with intakes as low as 1,700 mg (42.5 mmol)/day in male and 870 mg (21.7 mmol)/day in female patients with renal stones (Burtis et al., 1994), and (3) concern for the potential increased risk of mineral depletion in vulnerable populations due to the interference of calcium on mineral bioavailability, especially iron and zinc.

TABLE 4-11 Case Reports of Milk Alkali Syndrome (multi- and increasing doses)

 

Ca Intake (Dose 1) (g/d)

Duration (mo)

Ca Intake (Dose 2) (g/d)

Duration

Beall and Scofield, 1995

1 a

13

2.4 a

2 wk

 

1

13

4.2

2 wk

 

0.3 a

6

1.8 a

1 mo

Carroll et al., 1983

2.5

13

3

13 mo

Dorsch, 1986

Not reported

13

2.1 a

6 mo

Hakim et al., 1979

1 a

13

2.5 a

3.5 wk

Malone and Horn, 1971

Not reported

13

3 a

4.5 wk

Newmark and Nugent, 1993

Not reported

13

8.4 a

<1 y (“recent”)

Schuman and Jones, 1985

Not reported

13

4.6

6 wk

Number of Subjects

9

 

9

 

Mean

1.2

12

3.6

16.7

Median

1

13

3

4.5

Range

0.3–2.5

6–13

1.8–8.4

2–53 wk

a Data do not include intake of calcium from dietary sources.



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