Spasmophilia in children. Respiratory affective convulsions

) - This pathological condition, characterized by an increase in neuromuscular excitability and a tendency to clonic convulsions. It is observed mainly in children from 3 months to 2 years. Boys get sick more often.

Spasmophilia occurs as a result of a violation in the child's body of calcium-phosphorus metabolism (a drop in the calcium content in the blood). There are latent (latent) and explicit (manifest) forms of spasmophilia. Latent spasmophilia sometimes becomes apparent if the child receives small doses of vitamin D; the disease is in a certain connection with rickets (see).

Latent spasmophilia characterized by the appearance in the child of disturbing sleep, motor restlessness, fearfulness, increased sweating, and also various violations gastrointestinal tract. When examining a child, a number of characteristic features in the form of symptoms of Chvostek, Trousseau, Lust and Erb.

Khvostek's symptom (facial phenomenon) - with a slight tapping of the cheek with a finger between the zygomatic arch and the corner of the mouth, lightning-fast twitching of the mouth, nose and eyelids appears. Trousseau's symptom - when the neurovascular bundle on the shoulder is compressed, a convulsive contraction of the muscles of the hand occurs and it takes the position of the "obstetrician's hand". The phenomenon of Lust - when tapping below the head of the fibula, there is a rapid abduction and slight flexion of the foot. Erb's symptom, or increased galvanic neuromuscular excitability, - when the cathode is opened with a current of 3-2 and even 1 ma, irritation of the nerve in the elbow bend is accompanied by muscle contraction and flexion of the fingers.

Explicit spasmophilia manifests itself in the form of laryngospasm - a spasm of the glottis, sometimes occurring during the crying and crying of the child; laryngospasm is manifested by difficulty in breathing (inhalation), sometimes respiratory arrest; repeated attacks may occur during the day. Less common are carpopedal ("obstetrician's hand"), seizures of convulsions of the mimic muscles of the face. The most severe form of spasmophilia occurs in the form and is manifested by general clonic convulsions with loss of consciousness. There are convulsive contractions of the heart muscle with possible cardiac arrest and sudden death. Outside the attacks, increased neuromuscular excitability, positive symptoms of Khvostek, Trousseau, Lust remain. An explicit form of spasmophilia can last from several days to 2-3 weeks.

The diagnosis is established on the basis of the listed symptoms and biochemical data. It is important to timely identify the latent form of spasmophilia.

- children's disease early age characterized by a violation mineral metabolism, increased neuromuscular excitability, a tendency to spastic and convulsive states. Latent spasmophilia is manifested by contraction of the muscles of the face, hand ("obstetrician's hand"), a short-term cessation of breathing in response to a provocation; explicit spasmophilia occurs in the form of laryngospasm, carpopedal spasm and eclampsia. The diagnosis of spasmophilia is confirmed by the presence of hypocalcemia, hyperphosphatemia, and association with rickets. Treatment of spasmophilia includes help with general convulsions and laryngospasm, the appointment of calcium supplements, adequate therapy rickets.

General information

Spasmophilia (children's tetany) is a calciopenic condition, accompanied by a spastic state of the muscles of the face, larynx, limbs, general clonic or tonic convulsions. Spasmophilia is detected mainly at the age of 3 months to 2 years, i.e. in the same age range as rickets, with which childhood tetany has an etiological and pathogenetic connection. A few years ago, spasmophilia in pediatrics was quite common, but a decrease in the frequency severe forms rickets led to a decrease in the incidence of childhood tetany. Spasmophilia develops in 3.5 - 4% of children suffering from rickets; slightly more common in boys.

Clinical manifestations of spasmophilia in the form of laryngospasm or general convulsions with loss of consciousness and respiratory arrest require any medical specialist and parents of the ability and willingness to provide the child emergency care. A prolonged tetanoid state can cause damage to the central nervous system, subsequent mental retardation of the child, in severe cases - death.

Causes of spasmophilia

Spasmophilia is a specific disorder of calcium-phosphorus metabolism that accompanies the course of moderate or severe rickets. The pathogenesis of spasmophilia is characterized by a decrease in the concentration of total and ionized calcium blood on the background of hyperphosphatemia and alkalosis. An increase in the level of inorganic phosphorus in the blood can be facilitated by feeding a child cow's milk With high concentration phosphorus and insufficient excretion of excess phosphorus by the kidneys; hypoparathyroidism. In addition to calcium-phosphorus metabolism, with spasmophilia, hyponatremia, hypochloremia, hypomagnesemia and hyperkalemia are noted.

The spasmophilia clinic usually develops in early spring with the onset of sunny weather. Intense UV exposure to the skin of a child causes a sharp increase in the blood concentration of 25-hydroxycholecalciferol, an active metabolite of vitamin D, which is accompanied by suppression of the function parathyroid glands, changes in blood pH, hyperphosphatemia, increased deposition of calcium in the bones and a critical drop in its level in the blood (below 1.7 mmol / l).

Hypocalcemia causes increased neuromuscular excitability and convulsive readiness. Under these conditions, any stimuli (fright, crying, powerful emotions, vomiting, high fever, intercurrent infections, etc.) can trigger a seizure in a child.

It has been observed that children receiving breast-feeding, spasmophilia almost never develops. The risk group includes premature babies, children who are on artificial feeding living in unfavorable sanitary and hygienic conditions.

Classification of spasmophilia

Depending on the clinical course distinguish between latent (hidden) and manifest (explicit) forms of spasmophilia, while the transition is not excluded latent tetany into explicit.

Latent spasmophilia is detected only when special survey using mechanical and galvanic skin tests. At the same time, there are characteristic symptoms(Chvostek, Erba, Trousseau, Lust, Maslova).

Manifest spasmophilia can occur in the form of laryngospasm, carpopedal spasm and an attack of eclampsia.

Symptoms of spasmophilia

latent form

Flow latent spasmophilia always precedes an explicit one and can last several weeks or months. Children from hidden form spasmophilia usually have signs of rickets: excessive sweating, tachycardia , bad dream, emotional lability, increased anxiety, fearfulness, digestive disorders. The following symptoms indicate the presence of a latent form of spasmophilia:

Chvostek's symptom(upper and lower) - twitching of the corner of the eye or mouth when tapping with a hammer or finger along the zygomatic arch or angle mandible(i.e., the exit points of the branches of the facial nerve);
Trousseau's symptom- compression of the shoulder neurovascular bundle leads to convulsive contraction of the muscles of the hand, leading it to the position of the "obstetrician's hand";
Lust's sign- tapping in the area of the head of the fibula, in the projection of the exit peroneal nerve, accompanied by plantar flexion and abduction of the foot to the side;
Erb's sign- when irritated by galvanic current<5 мА срединного нерва в области локтевого сгиба происходит сгибание пальцев руки;
Maslov's phenomenon- pain irritation (prick) causes a short-term cessation of breathing in a child suffering from latent spasmophilia (in healthy children, such a reaction is absent).

Manifest spasmophilia

Laryngospasm, as a manifestation of explicit spasmophilia, is characterized by a sudden spasm of the muscles of the larynx, which often develops while the child is crying or for no apparent reason. A mild attack of laryngospasm is accompanied by partial airway occlusion, pallor, wheezing, reminiscent of whooping cough reprise. In severe cases, occurring with complete occlusion of the glottis, cyanosis, cold sweat, short-term loss of consciousness, apnea for several seconds, followed by a sonorous exhalation and noisy breathing; the child calms down and falls asleep. Spasm of the muscles of the larynx with spasmophilia can recur repeatedly during the day. In extreme cases, an attack of laryngospasm can lead to the death of the child.

Another manifestation of overt spasmophilia is carpopedal spasm- tonic spasm of the muscles of the hands and feet, which can last for hours or days. At the same time, there is a maximum flexion of the arms in large joints, bringing the shoulders to the body, flexion of the hands (fingers are gathered into a fist or bent like an "obstetrician's hand" - I, IV, V fingers are bent; II and III - unbent); plantar flexion of the foot, toes tucked in. Prolonged carpopedal spasm in spasmophilia can lead to reactive edema of the dorsum of the hands and feet.

With spasmophilia, isolated spasms of the eye muscles (transient strabismus), chewing muscles (trismus, stiff neck), and smooth muscles (impaired urination and defecation) can also occur. The most dangerous are spasms of the respiratory muscles, leading to dyspnea, bronchospasm and respiratory arrest, as well as the heart muscle, which threatens to stop the heart.

The most severe form of manifest spasmophilia is eclampsia or a general attack of clonic-tonic convulsions. The development of an attack of eclampsia is preceded by twitching of mimic muscles, then convulsions spread to the limbs and muscles of the body. General convulsions are accompanied by laryngospasm, respiratory failure, general cyanosis, loss of consciousness, foam on the lips, involuntary urination and defecation. The duration of an attack of eclampsia can vary from a few minutes to hours. This form of spasmophilia is dangerous in terms of stopping breathing or cardiac activity.

In children of the first 6 months. life spasmophilia often occurs in the form of laryngospasm and eclampsia; at an older age - in the form of carpopedal spasm.

Diagnosis of spasmophilia

With a clear form of spasmophilia, diagnosis is not difficult. The presence of clinical and radiological signs of rickets, complaints of muscle spasms and convulsions is taken into account. To identify latent spasmophilia, appropriate mechanical or galvanic skin tests are performed to assess neuromuscular excitability. A child with spasmophilia is examined by a pediatrician and a pediatric neurologist.

The diagnosis of spasmophilia is confirmed by a biochemical blood test that reveals hypocalcemia, hyperphosphatemia, and other electrolyte imbalances; the study of CBS blood (alkalosis).

Differential diagnosis of spasmophilia must be carried out with other hypocalcemic conditions, convulsive syndrome, true hypoparathyroidism, epilepsy, false croup, congenital stridor, whooping cough, etc.

Treatment of spasmophilia

An attack of laryngospasm or eclampsia requires emergency care for the child, and in case of respiratory and cardiac arrest, resuscitation. To restore spontaneous breathing in laryngospasm, splashing the child's face may be effective. cold water, shaking, patting the buttocks, irritating the root of the tongue, providing access fresh air. With inefficiency, artificial respiration and indirect heart massage are performed, humidified oxygen is supplied.

For any manifestations of apparent spasmophilia, the administration of anticonvulsants is indicated (diazepam intramuscularly, intravenously or at the root of the tongue, sodium oxybutyrate intramuscularly, phenobarbital orally or rectally in suppositories, chloral hydrate in an enema, etc.). Also shown in / in the introduction of 10% solution of calcium gluconate and 25% solution of magnesium sulfate / m.

With a confirmed diagnosis of spasmophilia, a water pause is arranged for 8-12 hours, then, until the symptoms of latent spasmophilia disappear completely, infants are transferred to natural or mixed feeding; older children are prescribed a carbohydrate diet (vegetable purees, fruit juices, tea with crackers, cereals, etc.).

To eliminate hypocalcemia, calcium gluconate is administered orally. After normalization of blood calcium levels and the disappearance of signs of spasmophilia, anti-rachitic therapy is continued. In the recovery period, gymnastics, general massage, long walks in the fresh air are shown.

Forecast and prevention

Identification and timely elimination of latent tetany avoids the clinical manifestation of spasmophilia. With the provision of timely assistance with convulsions and adequate correction of electrolyte disturbances, the prognosis is favorable. In extremely rare cases, in the absence of timely emergency care, the death of a child may occur due to asphyxia and cardiac arrest.

In its main provisions, the primary prevention of spasmophilia repeats the prevention of rickets. Breastfeeding plays an important role in preventive measures. The secondary prevention of spasmophilia consists in the treatment of the latent form of tetany, the control of blood calcium levels, the prophylactic administration of calcium supplements, and anticonvulsant therapy within 6 months after an attack of seizures.

Spasmophilia is an ailment characterized by the appearance of convulsions and spastic conditions directly related to hypocalcemia in the blood. In medicine, pathology is also called tetany. It is usually diagnosed in children aged 6 to 18 months.

Scientists have already found that spasmophilia is closely related to. Therefore, it is considered a childhood disease, but its progression in adults is not excluded. It is worth noting that this pathology is very dangerous, as it poses a threat not only to health, but also to the life of the child. Therefore, at its first symptoms, it is important to immediately begin to provide emergency care in order to prevent the development of complications (respiratory failure, convulsions, impaired consciousness).

Etiology

The main reason for the progression of spasmophilia in children is a lack of calcium. Therefore, often this disease begins to progress when:

hypervitaminosis of vitamin D. This is usually observed during the treatment of rickets;
inadequate and unbalanced diet. Nutrition plays an extremely important role in the normal development of the child, and especially in the first months of his life. It was found that spasmophilia progresses more often in children who are bottle-fed;
prematurity. The risk of developing the disease is several times higher in premature babies.

It is worth noting that this pathology often progresses in the spring, when sunlight becomes more intense. The reason for the development of spasmophilia in this case is the hyperproduction of vitamin D in the skin (under the influence of sunlight). This is especially dangerous for those children who are being treated for rickets and are already receiving this vitamin additionally.

Forms

Spasmophilia in children occurs in 2 clinical forms:

latent;
explicit.

latent form

In this case, the symptoms of spasmophilia are practically absent. They can be identified only with the help of a special examination. This is the greatest danger of a latent form - parents may not know that their child is developing such a dangerous pathology. The transition to an explicit form occurs after severe stress, illnesses of an infectious nature and other provoking factors.

explicit form

This form of spasmophilia occurs in three variants. One of them, or several at once, may appear:

. Spasm of the glottis occurs acutely. The lumen of the larynx may narrow partially or completely overlap. As a result, the following symptoms appear: voice change, respiratory failure. The attack does not last long (about 2 minutes). As a rule, after this the child falls asleep calmly;
spasm of feet and hands. Clinicians also refer to this condition as carpopedal spasm. Characteristic symptoms: the arms are tightly pressed to the body, the hands are in hypertonicity and bent, the lower limbs are also in a bent position. The duration of the spasm is from a couple of minutes to several hours. Emergency care is required to prevent the development of dangerous complications;
eclampsia. The most severe variant of the course of tetany. First, there are such symptoms: rare breathing, the child becomes numb. As the disease progresses, together with the indicated signs, convulsions of the whole body, involuntary biting of the tongue and urination are observed. Typically, such a seizure lasts less than half an hour, but cases have been recorded when it lasted several hours. It is important to immediately start providing emergency care to the child.

Symptoms

A patient with spasmophilia exhibits the following symptoms:

twitching of muscle structures is observed on the arms and legs;
spasms of the feet and hands;
possible occurrence of convulsions throughout the body. Usually this process is accompanied by biting the tongue, involuntary urination, impaired consciousness;
laryngospasm;

Since the main cause of the progression of the disease is vitamin D hypovitaminosis, which is observed in rickets, these symptoms can be supplemented by signs of this disease.

disease in adults

Spasmophilia in adults is much less common than in children. The underlying cause of the progression of this condition in adults is unknown. The fair sex is more often affected. Risk factors:

severe nervous strain;
the presence of ailments of an infectious nature;
childbearing and lactation;
hemorrhages;
the presence in the body of neoplasms of a benign and malignant nature;
extraction of the parathyroid glands.

Diagnostics

When the first signs indicating a pathology appear, you should immediately go to an appointment with a pediatrician or a pediatric neurologist. The standard diagnostic plan is as follows:

collecting anamnesis of the disease;
inspection. Gives the doctor the opportunity to identify the characteristic signs of rickets;
to assess the concentration of calcium;

Treatment

With the manifestation of symptoms indicating laryngospasm, it is necessary to immediately begin to provide emergency care to the child:

it is laid on a flat and hard surface;
if there is tight clothing, it must be unbuttoned or removed;
if possible, provide the child with fresh air;
it is important during emergency care to try to maintain a calm environment as much as possible so as not to frighten the child;
the skin on the face is sprayed with cold water;
the nasal mucosa is irritated with ammonia or tickled with a gauze swab.

If an attack begins, you should immediately call an ambulance. For its relief, specialists inject calcium gluconate or a 10% solution of calcium chloride into the vein. All this is carried out under constant control of heart rate. If first aid does not bring proper results, tracheal intubation is performed to ensure the normalization of respiratory function.

The most severe complication of spasmophilia is cardiac arrest. In this case, chest compressions should be started as soon as possible. After the attack is stopped, as a treatment, the child is prescribed to take vitamin D in medium doses for a month.

Complications

Without the lack of adequate and timely treatment, the child may experience:

convulsions;
respiratory dysfunction.

With early detection of pathology and restoration of calcium concentration, the prognosis is positive. The advanced form of the disease poses a serious danger to life and requires immediate emergency care.

Prevention

It is much easier to carry out the prevention of pathology than its treatment. If you adhere to the following recommendations, you can significantly reduce the risk of progression of spasmophilia:

children who are artificially fed, it is necessary to include natural donor milk in their diet;
complete nutrition. The diet includes cottage cheese, meat, milk, carrots, cabbage, etc.;
exact dosage of vitamin D.

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Diseases with similar symptoms:

Polyneuropathy is a complex of disorders characterized by damage to motor, sensory and autonomic nerve fibers. The main feature of the disease is that a large number of nerves are involved in the pathogenic process. Regardless of the type of illness, it manifests itself in weakness and atrophy of the muscles of the lower or upper limbs, their lack of sensitivity to low and high temperatures, and in the occurrence of painful and uncomfortable sensations. Paralysis is often expressed, complete or partial.

A parathyroid adenoma is a small, benign growth of 1 to 5 cm in size that can independently synthesize parathyroid hormone, causing symptoms of hypercalcemia in a person. The parathyroid glands are located on the posterior surface of the thyroid gland, and their main purpose is to produce parathyroid hormone, which is involved in calcium-phosphorus metabolism in the body. Adenoma leads to the fact that parathyroid hormone begins to be produced more than necessary, which causes the symptoms of this disease.

Intestinal obstruction is a severe pathological process, which is characterized by a violation of the process of release of substances from the intestine. This disease most often affects people who are vegetarians. There are dynamic and mechanical intestinal obstruction. If the first symptoms of the disease are detected, it is necessary to go to the surgeon. Only he can accurately prescribe treatment. Without timely medical attention, the patient may die.

Khlebovets N. I. - Associate Professor, Ph.D. honey. Sciences

Spasmophilia (Greek spasmos - spasm, spasm and philia - predisposition, tendency; synonym: infantile tetany, rachitic tetany) is a disease of children, predominantly of early age, characterized by a tendency to tonic and tonic-clonic convulsions, other manifestations of increased neuromuscular excitability due to a decrease in the level of ionized calcium in the extracellular fluid, as a rule, against the background of alkalosis.

Pathogenesis

The connection between spasmophilia and rickets was noticed long ago, but it was proved only in the 70s, when a low level of 25-hydrocholecalciferol (25-OH-D 3) was found in the blood of all examined children with spasmophilia. In the spring, against the background of the formation of small amounts of vitamin D under the influence of sunlight, the deposition of calcium in the bones increases, while its absorption in the intestine is small. Alkalosis caused by spontaneous or iatrogenic hyperventilation, prolonged vomiting, an overdose of alkalis when correcting acidosis, can be a provoking factor in the development of an attack of spasmophilia.

Clinical picture

Latent (latent) and overt spasmophilia should be distinguished, differing in the severity of the same pathological process. The disease is most often observed in the spring in children aged 6 to 18 months.

With a latent form, children are outwardly practically healthy, often well-fed, psychomotor development is within the normal range; almost always they have symptoms of rickets, most often in the recovery period.

The most common symptoms are the facial phenomenon of Khvostek (when tapping in front of the ear in the area of \u200b\u200bthe distribution of the branches of the facial nerve, lightning contractions of the facial muscles appear in the mouth, nose, lower, and sometimes upper eyelids); Erb's symptom (increased galvanic excitability of nerves - muscle contraction when the CRS cathode is opened at a current strength below 5 Ma); Trousseau's phenomenon (when the shoulder is compressed with an elastic tourniquet, convulsive contraction of the fingers occurs in the form of an obstetrician's hand); Maslov's symptom (with a slight prick of the skin in a child with spasmophilia, breathing stops at the height of inhalation; in a healthy child, such irritation causes an increase and deepening of respiratory movements; this phenomenon is clearly detected on a pneumogram); Peroneus phenomenon (rapid abduction of the foot upon impact below the head of the fibula in the region of n. fibularis superficialis - Lust's phenomenon).

With obvious spasmophilia in a child, most often when crying or fright, laryngospasm occurs - a spasm of the glottis, manifested by a sonorous or hoarse breath when crying and screaming and stopping breathing for a few seconds: at this moment, the child first turns pale, then he develops cyanosis, loss of consciousness, sometimes clonic convulsions join. The attack ends with a deep sonorous breath, after which the child almost always cries, but after a few minutes the child almost comes to a normal state and often falls asleep. In the most severe cases, death is possible as a result of sudden cardiac arrest (cardiac tetany), often with swelling of the back of the hands. Less commonly, there is a cessation of breathing not on inhalation, but on exhalation (bronchitis).

Carpopedal spasm - spasm of the distal muscles of the hand and foot, taking a characteristic position: the hand has the position of the "obstetrician's hand", the foot - the position of pes equinus, fingers, especially large ones, in plantar flexion. This condition of the hands and feet can be short-lived, but can persist for a long time - for several hours and even days; with spasm m. orbicularis oris lips take the position of the "fish mouth".

In the most severe cases, there are attacks of eclampsia - clonic convulsions that occur with loss of consciousness. They occur after short-term tonic convulsions. Eclamptic convulsions can be delayed or interrupted for a short time, completely stopping at the same time. Sometimes clonic convulsions join an attack of laryngospasm.

In children prone to spasmophilia, increased nervous excitability is usually noted (hyperreflexia, paresthesia, etc.).

Diagnosis and differential diagnosis

Diagnosis, as a rule, does not present significant difficulties. The presence of a child aged 6-18 months. clinical, biochemical and radiographic evidence of rickets and symptoms of increased neuromuscular excitability makes it mild. A typical attack of laryngospasm almost always allows us to consider it indisputable. ECG data indicate hypocalcemia (an increase in the QT complex for more than 0.2 s).

All patients have a decrease in the concentration of ionized calcium in the blood serum (below 0.9 mmol / l at a rate of 1.1–1.4 mmol / l) in combination with alkalosis (respiratory, less often metabolic). Reduced concentration of total calcium in the blood serum (less than 1.75 mmol / l at a rate of 2.5–2.7 mmol / l) is less common than a low level of ionized calcium.

Spasmophilia is differentiated from diseases that can cause tetany, an attack of seizures.

With hypoparathyroidism, which practically does not occur in infants, severe hypocalcemia and hyperphosphatemia are characteristic.

With renal osteodystrophy, a decrease in the content of calcium in the blood serum occurs against the background of acidosis, hyperphosphatemia, azotemia and other manifestations of chronic renal failure.

Transfusion of large amounts of citrate-stabilized blood in a hospital can lead to calcium binding in the blood, which, against the background of hyperkalemia, explains the seizures.

The eclamptic form must be distinguished from epilepsy, the attacks of which can occur in children of any age. History data, clinical picture and age of the child and EEG facilitate diagnosis.

Prevention

Basically the same as with rickets. It is important to strive to maintain breastfeeding as much as possible. In the spring, when symptoms of latent spasmophilia appear, calcium preparations must be prescribed.

Treatment

With laryngospasm ("kindred"), a dominant focus of excitation is created in the brain by irritating the nasal mucosa (they blow into the nose, tickle, bring ammonia), skin (prick, patting and dousing the face with cold water), vestibular analyzer (“shaking” the child), changes in body position.

With convulsions intramuscularly or intravenously, seduxen (diazepam) 0.1 ml 0.5% solution / kg body weight or magnesium sulfate 0.2 ml / kg 25% solution, GHB (sodium oxybutyrate) 0.5 ml / kg (80–100 mg / kg) of a 20% solution and, at the same time, slowly intravenously calcium chloride 0.2 ml / kg of a 10% solution or calcium gluconate 0.2 ml / kg of a 10% solution. Calcium preparations are preliminarily diluted 2 times with 10% glucose solution and administered intravenously slowly, because. rapid administration of calcium supplements can cause bradycardia and even cardiac arrest.

The child is hospitalized in a hospital after the disappearance of seizures.

It is desirable to transfer a child fed artificially to feeding with expressed milk from a donor or mother. If this is not possible, it is necessary to limit the content of cow's milk in the diet as much as possible (due to the large amount of phosphates) and increase the amount of vegetable complementary foods.

In the post-attack period, calcium preparations are prescribed orally. 5–10% solution of calcium chloride or calcium gluconate at the rate of 0.1–0.15 g/kg (1 ml/kg) per day; calcium carbonate is better absorbed in combination with a citrate mixture (citric acid 2.1 g, sodium citrate 3.5 g, distilled water up to 100 ml) 5 ml 3 times a day. You can prescribe calcium - D3 Nycomed (calcium carbonate 1250 mg - equivalent to 500 mg), vitamin D3200ME) 1 tablet per day.

3-4 days after the attack, patients with obvious spasmophilia should be given vitamin D2 at 4000-8.000 IU 2 times a day. The method of choice may be the appointment inside 0.1% solution of dihydrotachysterol at 0.05-0.1 mg / day (1-2 drops 2 times a day). Positively affecting hypocalcemia, the drug does not have vitamin D activity.

To create acidosis, a 10% ammonium chloride solution is prescribed (1 teaspoon 3 times a day).

Calcium therapy and restriction of cow's milk should be continued until the symptoms of latent spasmophilia completely disappear. It is necessary to limit as much as possible or perform with extreme caution all procedures that are unpleasant for the child (examination of the pharynx, injections, etc.), which can cause a severe attack of laryngospasm.

Forecast

Favorable. Very rarely severe attack laryngospasm, if emergency care is not provided, ends fatally. A very prolonged eclamptic state can adversely affect the central nervous system - there may be a delay in the future mental development.

Chronic eating disorders in young children

Volkova M.P. - Associate Professor, Ph.D. honey. Sciences

The state of normal nutrition - normotrophy, eutrophy (A. M. Tour) - is characterized by physiological growth and weight indicators, clean velvety skin, a properly developed skeleton, moderate appetite, physiological functions normal in frequency and quality, pink mucous membranes, and the absence of pathological disorders from the internal organs, good resistance to infection, proper neuropsychic development, positive emotional mood.

Eating disorders are pathological conditions that develop as a result of insufficient or excessive intake and / or absorption of nutrients. Eating disorders are characterized by a violation of physical development, metabolism, immunity, morphofunctional state of internal organs and body systems.

In ICD 10, nutritional deficiencies are referred to as protein-energy malnutrition (PEM).

According to ICD-10, the following headings are included in the group of eating disorders:

E40-46 - protein-energy deficiency. (hypotrophy: prenatal, postnatal).

E50-64 - other nutritional deficiencies (vitamin and microelement deficiencies).

E65-68 - obesity and other types of malnutrition.

Spasmophilia- a disease characterized by tendency to tonic and tonic-clonic seizures in connection with a violation of mineral metabolism and CBS, leading to increased mechanical and galvanic neuromuscular excitability.

Predisposing factors

Spasmophilia mostly affects children. early age from 3 months to 2 years with symptoms of severe rickets. Children older than 3 years are relatively rarely affected. The frequency at an early age is 3-4%. Spasmophilia affects young children who are bottle-fed with unadapted mixtures and have symptoms of rickets. More often it develops in the spring.

Causes. Pathogenesis.

The immediate cause of the disease is a decrease in ionized calcium in the blood, which is promoted by alkalosis and hyperphosphatemia. The connection between rickets and spasmophilia is well known. Most researchers believe that spasmophilia and rickets are pathogenetically two different phases of a calcium and phosphorus metabolism disorder that develops as a result of a lack of vitamin D in the body. Distinctive features of metabolism in spasmophilia should be considered pronounced hypocalcemia (with rickets it is moderate), alkalosis (with rickets-acidosis), hypofunction of the parathyroid glands (with rickets, the functional activity of these glands is increased).

The main clinical manifestations of spasmophilia - spasm and convulsions - are explained by a sharp calcium deficiency and the increased excitability of the nerves caused by it.

Spasmophilia occurs at any time of the year, but with the greatest frequency in the spring, especially in those cases when there is a rapid change from cloudy days to bright, sunny ones.

To provoke an attack of spasmophilia can any disease with high temperature, frequent vomiting in gastrointestinal diseases, as well as strong crying, excitement, fear, etc.

Diagnostic criteria

Reference features

With hidden form:

symptom tail- lightning-fast contraction of muscle muscles when the cheek is tapped with a finger between the zygomatic arch and the corner of the mouth;

symptom Trousseau- convulsive contraction of the hand in the form of an "obstetrician's hand" during compression of the neurovascular bundle in the shoulder area;

symptom Lusta- rapid abduction of the foot upon impact below the head of the fibula;

Maslov's phenomenon- respiratory arrest at the height of inhalation with a slight prick of the skin (in a healthy child - quickening and deepening of breathing);

symptom Erba- contraction of the median nerve in the elbow bend when irritated by a galvanic current of less than 5 mA (normally more than 5 mA).

With an explicit form:

laryngospasm- slight or complete spasm of the glottis. Cyanosis, bulging eyes, the child is covered with sticky sweat. Then a noisy breath - "cock's cry." Duration - from several seconds to 1-2 minutes. Seizures may recur;

carpopedal spasm- tonic contraction of the muscles of the foot and hands. Hands in the form of an "obstetrician's hand", feet in a state of sharp plantar flexion;

eclampsia- a general attack of tonic-clonic convulsions with loss of consciousness. Duration - from several seconds to 20-30 minutes. Frequent attacks may give a picture of Statuseclampticus.
All symptoms of latent and overt spasmophilia are noted against the background of symptoms of rickets.

Optional features:

increased nervous excitability hyperreflexia, paresthesia);

a decrease in the content of ionized calcium in the blood serum below 0.9 mmol/l(at a rate of 1.1-1.4 mmol / l);

respiratory, rarely metabolic alkalosis;

on the ECG interval increaseQ-T > 0.2 With.

Laboratory and instrumental research methods

Main methods:

determination of the content of total and ionized calcium in blood serum;

definition of KOS.

Additional methods:

determination of the level of inorganic phosphorus in blood serum;

Sulkovich test.

Variants of the clinical course depend on the form of spasmophilia. latent form precedes explicit and can last from several weeks to several months. Usually hidden spasmophilia goes into explicit under the influence of provoking moments (various intercurrent diseases). The most severe manifestation of an explicit form - eclampsia (a generalized attack of tonic-clonic seizures with loss of consciousness). In mild cases, the attack may be limited to pallor, numbness, twitching various groups muscles, especially the face. After the attack, the children fall asleep.

Clinical course depends on the age of the child. In children of the 1st year of life, laryngospasm and attacks of general convulsions are more often noted, and older than a year- carpopedal spasm. At untimely treatment spasmophilia can acquire a relapsing course

Condition severity criteria: the presence of convulsive syndromes, especially laryngospasm, bronchospasm.

Complications: the most formidable is acute respiratory failure.

Disease duration: with timely pathogenetic, symptomatic treatment duration acute period disease ( convulsive syndrome, fearfulness, anxiety, disturbing dream, laringo-, bronchospasm (maximum 20-30 minutes).

Forecast. At timely diagnosis and adequate treatment is favorable.

Urgent Care

It is necessary to create a calm environment, lay the child with his head turned slightly to one side, carefully support the head and limbs to prevent bruising. Oxygen therapy should be provided.

For the relief of convulsions are shown: 1) chloral hydrate in the form of a 2% solution (temperature 38-40 ° C) in the amount of 20-30 ml per enema (you must first make a cleansing enema), if convulsions do not stop, the enema from chloral hydrate can be repeated after 20-30 minutes ; 2) sodium sulfate ( magnesium sulfate) in the form of a 25% solution intramuscularly at the rate of 0.2 ml / kg with 2 ml of a 0.5-1% solution of novocaine; 3) phenobarbital orally and in suppositories at a dose of 0.005-0.01-0.015 g per dose, barbamyl 0.01-0.015 g per appointment in an enema or suppositories.

If convulsions are combined with high body temperature, intramuscular administration of a 2.5% solution of chlorpromazine is indicated at the rate of 1 mg per 1 kg of body weight. With frequently recurring attacks of clonic-tonic convulsions, with a bulging of a large fontanel, it is necessary to do lumbar puncture with the removal of 8-10 ml of liquid.

Sometimes, to eliminate attacks of laryngospasm, a general irritation in the form of splashing with cold water, patting on the buttocks, irritation of the root of the tongue, the wall of the pharynx, several methods of heart massage, artificial respiration until the first breath appears is sufficient.

Treatment.

Prehospital stage:

limit milk in the diet;

transfer the baby to breastfeeding breast milk or adapted mixtures;

5% or 10% solution calcium chloride 1 teaspoon 3 times a day or calcium gluconate 0.5 g 3 times a day;

5% solution ammonium chloride 1 teaspoon 3 times a day;

3-4 days after the appointment of calcium supplements vitaminD2 at therapeutic dose;

with laryngospasm - create access to fresh air, irritate the nasal mucosa, the root of the tongue and back wall throat, skin, bring ammonia to the nose and etc.;

with convulsions : magnesium sulfate - 25% solution, 0.25 ml / kg,

seduxen - 0.5% solution, 0.1 ml / kg, or GHB - 20% solution, 0.5 ml / kg / m.

Criteria for correct treatment:

improvement clinical manifestations diseases, disappearance of symptoms of latent and overt forms of spasmophilia;

Normalization of laboratory parameters.

Indications for consultation of narrow specialists

With increased excitability, convulsive readiness - consultation of a neurologist; with laryngospasm - an otolaryngologist.

Indications for hospitalization: obvious spasmophilia; difficulties in diagnosis.

hospital stage:

intravenous administration 10% calcium gluconate solution or 10% calcium chloride solution;

other medical measures- see Treatment at the pre-hospital stage.

Rehabilitation after discharge from the hospital- see Rickets.

Prevention

Prevention of rickets (see);

preservation of natural feeding;

calcium supplements, especially when breastfeeding;

excitable children - bromine preparations

Outcomes.

The prognosis in most cases is favorable, very rarely a severe attack of laryngospasm can be fatal. A strongly protracted eclamptic state can adversely affect the central nervous system - in the future, mental retardation is possible.