Burnett's syndrome – the dismetabolichesky disease developing after reception of reabsorbiruyemy alkalis: milk, carbonates of calcium, magnesium. It is characterized by a giperkaltsiyemiya and a zashchelachivaniye of an organism. It is shown by disgust for milk food, attacks of nausea and vomiting, bystry fatigue, apathy, a skin itch. Work of kidneys is broken, there are articulate and muscular pains. Diagnostics includes identification of a giperkaltsiyemiya and alkaloz by means of laboratory techniques, definition of deposits of calcium by method of a palpation and a X-ray analysis. Therapy comes down to cancellation of medicines of calcium, correction of a milk medical diet and elimination of dehydration.
The widespread name of a syndrome of Burnett – a dairy and alkaline syndrome. Such synonyms as a syndrome of an alkaloz, a dietary giperkaltsiyemiya, dairy poisoning are less often used. For the first time the negative impact of milk and alkalis on metabolism was noted still by the Ancient Greek healer Hippocrates. The detailed description and allocation of independent nosological unit was prepared by the American doctor Ch. Burnett in 1949. Prevalence of a syndrome in the general population makes about 1%, among the people with gastritis and stomach ulcer adhering to a milk diet – 30%. The disease is more often diagnosed for men. Epidemiological indicators considerably increased for the last decades that is connected with wide circulation of the dietary supplements containing calcium.
Reasons of a syndrome of Burnett
In risk group on development of a syndrome there are persons with violation of regulation of absorption of calcium through intestines and with decrease in functional ability of kidneys. Strengthening of absorption of a microcell and its connections can happen at a gipervitaminoza of D, a giperparatireoza, a thyrotoxicosis. Diseases of an urinary system complicate removal of surplus of Ca+. Burnett's syndrome provoked by reception of medicines most often develops at the following pathologies:
- Osteoporosis. Density of bones decreases, collapses their organic . For completion of mineral deficiency kaltsiysoderzhashchy means are appointed.
- Gastritis. The inflammation of a mucous membrane of a stomach is provoked by the increased acidity of gastric juice. Apply antatsida to decrease of the activity of hydrochloric acid – alkaline medicines.
- Stomach ulcer of a stomach. Antatsidny means reduce intensity of painful feelings, displays of heartburn. Also, as well as at gastritis, calcium the carbonate neutralizes gastric acid.
Are the cornerstone of Burnett's syndrome a giperkaltsiyemiya, metabolic and renal dysfunction. The disease develops step by step. The active use of milk, reception of vitamin and mineral complexes and antatsidny means leads to excess absorption of calcium from intestines and to development of a giperkaltsiyemiya of easy degree. Increase in level of calcium in plasma promotes strengthening of an ekskretion of sodium through kidneys. Dehydration accrues, secretion of paratireoidny hormone – the regulator of concentration Ca + in a blood-groove is suppressed. The kidney reabsorption of bicarbonate increases, it is formed – accumulation of alkaline connections and increase in pH of blood. Reduction of speed of a glomerular filtration and is stimulated by processes of repeated absorption of calcium with kidneys, the giperkaltsiyemiya becomes moderate or heavy.
Ch. Burnett and colleagues allocated and described two forms of a syndrome: reversible which manifestations are reduced right after decrease in a dosage of calcium, and irreversible which symptoms remain for many years, despite cancellation of kaltsiysoderzhashchy medicines and milk. Now similar classification which cornerstone character of a course of disease is is used:
- Sharp form. Develops several days later after the beginning of a dairy and vegetable diet, reception of antatsid and medicines of calcium. The moderate or heavy giperkaltsiyemiya, , a moderate azotemiya, easy increase in phosphates of blood is characteristic. Symptoms are reversible.
- Chronic form. Progresses gradually, within several months, years. Giperkaltsiyemiya heavy and resistant, violations of work of kidneys irreversible, in skin, joints, muscles are formed kaltsifikata. There is a risk of a lethal outcome owing to a renal failure.
Symptoms of a syndrome of Burnett
At the initial stages the syndrome is shown by the general weakness, block, lack of appetite, nausea and vomiting. Patients have feeling of disgust at a look and a smell of milk or dairy dishes. One of symptoms is the polyuria – plentiful frequent urinations. In the absence of medical care dehydration develops, thirst amplifies, dryness in a mouth, a skin itch, headaches appears. Adjournment in fabrics of salts of calcium provokes muscle, joints and sinews pains, formation of dense small knots under skin. At some patients cartilaginous tissues, hypodermic vessels are condensed, there are whitish impregnations on a conjunctiva and a skler. Skin becomes covered by the shelled psoriazopodobny rash. Large joints are painful, increased because of kaltsifikat and hypostases. The heavy current of a syndrome is followed by changes in work of TsNS, emergence of an ataxy, consciousness obscuring.
The long giperkaltsiyemiya provokes development of a nefrokaltsinoz. Active inflow of calcium raises load of kidneys. Kaltsinata collect in a kidney parenchyma. The epithelium covering kidney tubules atrophies. Cages perish, salt deposits are formed in tubules. Expanding, they turn into cylinders which completely cork a gleam. Deposits of salts stimulate cell fission of connecting fabric which gradually replaces a functional parenchyma. Kidney balls are wrinkled, nephrosclerosis develops. Against the background of these complications there are inflammatory and infectious processes, for example, pyelonephritis, an urolithic disease.
Primary examination is conducted by the doctor-endocrinologist. At poll patients report about intolerance of a smell and type of milk, nausea, vomiting, the general weakness, articulate and muscular pains, an itch and dryness of skin. In the anamnesis gastritis, stomach ulcer, osteoporosis, the long use of a hydrocarbonate of sodium (20 g/days), milk (2-3 l/days) often is defined. For confirmation of the diagnosis of a syndrome of Burnett and his differentiation with gipervitaminozy D, chronic nephrite, giperparatireozy and nefrokaltsinozy perform specific diagnostic procedures:
- General survey. At a palpation consolidation of auricles, walls of hypodermic vessels is defined. On skin – a peeling, psoriazopodobny rash. At palpation of large joints patients note pain, puffiness is externally observed, bone small knots are palpated. A typical sign – morbidity of Achilles tendons.
- Blood test. By results of biochemical blood test the increased calcium level, excessive concentration of residual nitrogen (not necessarily), is diagnosed (surplus of the alkaline bases, pH indicator more than 7). According to the general analysis – the increased SOE (40-60 mm/hour).
- Analysis of urine. The raised indicators of protein and leukocytes, single erythrocytes and cylinders are characteristic. Giperkaltsiuriya usually is absent, urine reaction alkaline. At a heavy current of a syndrome with complications the leykotsituriya is possible.
- Skull X-ray analysis. In pictures there are signs of consolidation of bones of a skull. The Yacheistost disappears, transparency of bosoms goes down.
- Ophthalmologic survey. The long course of a disease provokes with damage of eyes. Adjournment of kaltsinat in a conjunctiva comes to light, is more rare – in a cornea.
Treatment of a syndrome of Burnett
Primary medical events are held on the basis of a hospital, after improvement of health of the patient transfer to out-patient observation. Therapy is aimed at elimination of the reasons of an alkaloz and giperkaltsiyemiya, restoration of water and electrolytic balance, correction and continuation of treatment of the main disease, complications. Are included in the scheme of actions:
- Cancellation of medicines of calcium. The patient with gastritis, stomach ulcer of a stomach and a 12-perstny gut instead of the soaking-up antatsid appoint H2 blockers, not soaking up salts. Kaltsiysoderzhashchy dietary supplements are cancelled, the dosage of tiazidny diuretics, estrogen, vitamins D and A decreases.
- Change of a diet. For the patients having high acidity of gastric juice the principles of food are corrected. The volume of milk, dairy products in a daily diet is reduced. Other rules remain.
- Regidratation. Intravenous administration of 5% of solution of glucose, solution of sodium of chloride, chloride potassium (is carried out at a gipokaliyemiya). Procedures restore balance of electrolytes, reduce dehydration symptoms, promote restoration of function of kidneys, a rassasyvaniye of small knots and consolidations under skin and in joints.
Forecast and prevention
In most cases manifestations of a syndrome of Burnett are reversible, reduction of the calcium arriving through a GIT is the most effective method of treatment. For prevention of a disease the patients accepting kaltsiysoderzhashchy medicines need to observe strictly the dosage appointed by the attending physician periodically to control concentration of calcium of blood. The soaking-up antatsida are recommended to be replaced on not soaking up (medicines of salts of aluminum and magnesium), to reduce amount of milk, and also the products made of it.