Following up on the discussion of milk-alkali syndrome, a similar syndrome (hypercalcemia, metabolic alkalosis, and acute renal failure) may also occur due to betel nut chewing. Betel nut chewing is a common habit and cultural practice amongst Indian and Southeast Asian populations. Generally, betel leaves are used to wrap a type of nut (the areca nut) and then chewed. Because of its bitter taste, alkaline calcium salts--mineral-slaked lime in the form of calcium hydroxide--are traditionally added to the mixture. Because of the presence of calcium & base, a small fraction of individuals who frequently participate in betel nut chewing can develop milk-alkali syndrome. So add "Chew any betel nuts recently?" to your list of bizarre questions to ask patients with unexplained hypercalcemia.In Taiwan, "betel nut beauties" refer to scantily-clad young women who sell betel nuts and cigarettes at small kiosks, apparently a common site in big cities.
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