Spasmophilia in children symptoms. Carpopedal spasm and its features

Spasmophilia - increased excitability nervous system, predisposition to cramps of individual muscle groups or the whole body.

Most often this is a childhood disease, which affects children from 2 months to 2 years. Children who are on artificial feeding or premature. The disease often occurs in the spring, but is very rare in the summer. Spasmophilia affects children with signs of rickets. Spastic states and convulsions are observed, as a rule, in boys.

Spasmophilia manifests itself in the form of attacks of convulsions and laryngospasm (acute narrowing of the glottis), respiratory arrest, and loss of consciousness. IN bloodstream The level of vitamin D sharply rises, the level of magnesium, sodium, vitamins B1 and B6, and chlorides decreases. Urgent required resuscitation measures. A long-term state of spasmophilia leads to damage to the nervous system, as well as developmental delays mental state child.

Causes

The cause of spasmophilia is considered to be a failure of phosphorus-calcium metabolism. The calcium content in the blood decreases noticeably. At the same time, the phosphorus content increases. This may be influenced by the use cow's milk with an increased concentration of phosphorus and insufficient removal of phosphorus by the kidneys.

Lack of calcium (hypocalcemia) leads to increased muscle and nervous excitability. In this condition, any irritant can cause a convulsive attack in the child.

To the reasons causing development spasmophilia include:

Artificial feeding.
Unfavorable sanitary and hygienic environment in which the child has to be a long period time.

Symptoms

Symptoms of spasmophilia are associated with the clinical course of the disease, which has 2 forms:

Explicit.
Hidden (latent).

The latent form always precedes the explicit form. This is why diagnosing the disease at the initial stage is difficult.

Outwardly this manifests itself in the appearance muscle cramps, all kinds of disorders of the functioning of the nervous system.

The latent form of the disease is characterized by the following symptoms:

Convulsive contraction of the hands when squeezing the child’s shoulder (Trousseau’s symptom);
When you touch the cheekbones, an involuntary contraction of the muscles in the corners of the mouth and eyes is noticeable (Chvostek's symptom);
Slight flexion and rapid abduction of the foot to the side with gentle tapping (Lust's symptom);
Increased nervous excitability (Erb's symptom);
Stopping breathing due to painful stimulation (Maslov’s symptom);
Muscle contraction when acting on the median nerve of the elbow joint.

In addition, certain signs of rickets are often noticeable:

Increased sweating;
Digestive dysfunction;
Restless sleep.

Any symptom requires immediate appeal to the doctor.

Diagnostics

The diagnosis is made taking into account the following studies:

General and biochemical analysis blood;
Blood alkalosis (increased pH);
Analysis for hypocalcemia and hyperphosphatemia;
X-ray examination.

When making a diagnosis, the child’s age, type of feeding and time of year are taken into account.

Treatment

Treatment of spasmophilia is predominantly medicinal. In severe cases, the child must be hospitalized. Treatment directly depends on the manifestations of the disease and general condition patient.

In case of severe laryngospasm (loss of consciousness, respiratory arrest), urgent resuscitation measures are required. With prolonged laryngospasm, asphyxia (suffocation) appears. To eliminate it, an oxygen mask and artificial respiration are indicated.

The child should be given drinks often (tea, berries and fruit juices). Limit intake of cow's milk. Calcium preparations are required: calcium gluconate and calcium chloride solution 10%.

3 weeks after the seizures are relieved, antirachitic treatment is carried out. Limit or perform very carefully all procedures that are unpleasant for the child (injections, examination of the pharynx), which can cause an attack of laryngospasm. Very severe attacks may end fatal. But this happens extremely rarely.

To relieve spasms they are prescribed anticonvulsants. Preference is given to seduxen. It acts instantly, but only for a short time. Gamma-hydroxybutyric acid is used. It is administered intravenously, intramuscularly or orally. Simultaneous administration of these drugs is allowed. Hydrochloride can be administered using an enema.

During an attack of laryngospasm you need:

Place the child on a flat and hard surface.
Unbutton your clothes and provide fresh air.
Spray your face cold water, ammonia can cause irritation of the nasal mucosa.
Inject intravenously calcium gluconate or intramuscular relanium.

If the attack cannot be stopped, then indirect massage heart muscle.

Folk remedies

As an additional remedy can be given to a sick child:

Warm infusion of herbs chamomile, caraway, mint, taken in equal parts. The duration of treatment is 10 days.
Wild chicory. 1 tsp Add chicory roots to a glass of water, boil for 10 minutes, drink before meals.
Eucalyptus. Inhale eucalyptus decoction through your nose every day for at least 15 minutes. For bathing, add 20 grams of plant leaves per 10 liters of water.

Complications

With spasmophilia, the course of all diseases is significantly aggravated. Paralysis of the heart muscle is possible with prolonged illness.

Prevention

Prevention of spasmophilia is identical to the prevention of rickets and includes next row measures:

Balanced diet including cottage cheese, fermented milk products, meat, vegetables;
If breast-feeding is impossible, then the mixtures must contain calcium, phosphorus and magnesium;
For prevention, you need to take vitamin D. In the spring and summer months, the vitamin is not taken to avoid an overdose;
It is required to take calcium supplements and constantly monitor its content in the blood;
Shown preventive massage and daily walks in the fresh air;
Examination by a pediatrician - monthly, by a neurologist - once a quarter.

The prognosis for treatment of spasmophilia is favorable in most cases. With timely diagnostic activities and adequate treatment, there are no relapses, and harm to the child’s health is unlikely.

Spasmophilia is a disease of early childhood, which at timely treatment has a favorable prognosis. The disease rapidly develops as a result of hypocalcemia (lack of Ca in the body), while the content of vitamin D in the blood increases.

The rapid development of spasmophilia in children is facilitated by irregularities in work parathyroid glands , decreased level of calcium absorption in the intestine or increased level excretion of Ca along with urine. Frequent seizures provoked by a lack of levels of Mg, Na, chlorides, B vitamins in the blood. When identifying the slightest symptoms spasmophilia is necessary urgently contact a pediatric neurologist. On early stage drug therapy allows you to eliminate symptoms and protect your baby from negative consequences in future. Unfortunately, late detection of spasmophilia provokes serious complications for the whole body and deterioration in the child’s quality of life. Treatment of spasmophilia involves urgent hospitalization of the patient.

Causes

The main causes of spasmophilia are the following factors:

excess vitamin D (due to an overdose of the drug during treatment or as a result of prolonged exposure to the sun);
poor nutrition;
breastfeeding replacement artificial mixtures;
feeding infant cow's milk;
various kidney disease, which cause problems in mineral processing associated with large deposits of calcium in the urine;
premature birth(from 33 weeks of pregnancy);
unfavorable sanitary and hygienic living conditions.

Seizure attacks with spasmophilia, as a rule, can be triggered by stress, loud sounds, bright light, etc.

Classification

Spasmophilia can occur in two forms: latent (hidden) and obvious.

Latent form suggests the absence of significant symptoms. The first signs of spasmophilia can only be noticeable with careful diagnosis by an experienced neurologist. The disease becomes obvious when exposed to associated factors, including stress, overexertion, infectious lesion organs and systems of the body. Average duration spasmophilia in latent form – from 2 to 6 months. In the absence of diagnosis and treatment, the disease becomes obvious.

At explicit form spasmophilia, spasticity of the glottis is observed, against which the child’s voice becomes rougher, he has difficulty pronouncing sounds, the process of humming is disrupted, and there is a delay speech development. Also often spasms occur, hands and feet are in a flattened, tucked form, arms are brought to the chest. The spasms may last for several minutes or hours. Also with this form it is noted rapid breathing and heartbeat, sometimes - long delays in breathing (apnea). In severe cases of spasmophilia, seizures accompanied by eclampsia and loss of consciousness. Sometimes the child falls asleep immediately after a seizure, but muscle spasms are saved. In such cases it is necessary urgent hospitalization with subsequent observation by a neurologist.

Symptoms

The main signs of the disease are:

spasms of muscles of various groups;
curled toes downwards;
“twisting” of the brushes;
twitching of limbs;
improper formation of the hand and fingers;
hoarse voice, rapid breathing;
increased sweating;
in children;
increased neuromuscular excitability;
decreased concentration;
skeletal disorders (spinal curvature, severe frontal lobes, O-shaped or X-shaped legs, curved chest);
disruption of the digestive process;
poor sleep;
twitching of facial muscles;
general cyanosis;
increased pain sensitivity.

Diagnostics

To diagnose the disease, the following manipulations are performed:

examination by a neurologist;
examination by a pediatrician;
galvanic skin tests;
blood chemistry;
general blood analysis;
general urine analysis;
mechanical tests.

Diagnosis of spasmophilia must be carried out by specialists in the field of pediatrics and neurology. Based on the research results, optimal therapy and prevention of recurrent seizures can be recommended.

Treatment

In children, spasmophilia should be treated exclusively under the supervision of a doctor. In most cases, treatment in a hospital setting with consistent monitoring of the patient is appropriate.

Basic methods of conservative therapy:

intravenous administration solutions of magnesium, calcium;
taking sedatives;
diet therapy(infants are prescribed a “tea diet” for 6-12 hours, during which they are given weak tea in limited quantities, then breast milk is introduced, fermented milk products; adult children are prescribed fruits and vegetables in the form of purees, vitamins);
administration of a solution of chloral hydrate (intramuscularly or through an enema).

After completing the course, they are assigned preventive actions against, including massage, gymnastics and frequent walks in the fresh air.

Urgent assistance in the event of a seizure attack involves:

placing the child on a flat, hard horizontal surface (floor, couch, table);
liberation chest from clothes;
providing a direct supply of fresh air;
insertion of a breathing tube into the throat;
wetting the face with cold water;
indirect cardiac massage;
urgent administration of anticonvulsant drugs.

Disease prevention

Prevention of spasmophilia includes a number of measures. First of all, it is necessary to have a comprehensive regular meals , including drinking milk, fermented milk products, cottage cheese, vegetables, meat while maintaining breastfeeding. If this is not possible, mixtures with the optimal content of calcium, magnesium, and phosphorus are prescribed. Also, for children with spasmophilia, preventive taking vitamin D in the first year of life (1 drop per day), while in the summer and spring it is recommended to stop taking this vitamin to avoid an overdose. Constantly necessary monitor blood calcium levels, take calcium supplements in a timely manner. Good effect They also provide frequent walks in the fresh air and therapeutic and preventive massage. To prevent spasmophilia, children in the first year of life should undergo monthly examinations by a pediatrician; at least once a quarter - with a neurologist.

Forecast

If the child has had timely diagnosis, rendered complex treatment, then the prognosis for spasmophilia positive. It is very important to provide timely assistance with convulsive syndrome, correct electrolyte disturbances in the body, and establish proper and regular nutrition. In the absence of help, especially during seizures, the child may die as a result of cardiac arrest or asphyxia. Treatment of spasmophilia should be prescribed exclusively by an experienced neurologist, as well as prevention of this disease after recovery.

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The content of the article

Spasmophilia(infantile tetany) is a disease associated with rickets. The essence of spasmophilia is a violation of mineral metabolism, an increase in mechanical and galvanic neuromuscular excitability and the appearance of attacks of tonic and clonic convulsions. Children mainly from 2 months to 2 years of age are affected, and relatively rarely - children older than 3 years. Convulsive syndrome in children under 3 months is most often associated with pathology of the newborn period ( intracranial injuries). Spasmophilia occurs in 3.5 - 4% of children in the first two years of life.

Etiology of spasmophilia

The etiology of spasmophilia has much in common with the etiology of rickets.
With tetany, feeding plays an important role: children fed breast milk, almost never suffer from tetany. Premature babies are more likely to suffer from spasmophilia. There is a certain seasonality - the disease most often occurs in early spring, and almost never occurs in summer. Tetany affects children who have signs of rickets.
N. F. Filatov pointed out the connection between rickets and non-febrile convulsions in children aged 6 months to 2.5 years. They provoke an attack of spasmophilia, digestive disorders, vomiting, increased body temperature, prolonged crying, various diseases.

Pathogenesis of spasmophilia

The basis of the disease is a violation of phosphorus-calcium metabolism due to insufficiency of ergocalciferol, disorders of its metabolism, function regulatory systems(hyperparathyroidism), metabolic disorders.
The main biochemical changes are hypocalcemia (calcium level in the blood is below normal - up to 2 - 1.75 mmol/l (0.08 - 0.07 g/l), normal - 2.25 - 2.5 mmol/l (0 .09 - 0.1 g/l); relative hyperphosphatemia over 2.74 mmol/l (0.054 g/l) and alkalosis - pH 7.65 (normal - pH 7.35) contribute to a decrease in the amount ionized calcium. About 50% of calcium in the blood is bound to protein, does not diffuse through membranes, and has no effect on neuromuscular excitability. The second part is heterogeneous. About 20% of calcium is in an ionized state, 30% is in the form of bicarbonates. The amount of ionized calcium depends on the pH of the blood. With alkalosis, the dialysing (not bound to protein) part of calcium and its ionized part, which affects the state of neuromuscular excitability, decrease. In addition, with spasmophilia, a decrease in calcium content in cerebrospinal fluid up to 0.5 mmol/l - 0.02 g/l (normally 1.25 mmol/l - 0.05 g/l). The potassium content in the blood is increased.
A number of other electrolytes also have an effect on neuromuscular excitability. Thus, Na+ and K+ ions increase the excitability of the neuromuscular system, Ca2+ and Mg2+ - reduce it. Frequent vomiting, hyperventilation with prolonged crying, increased body temperature, etc. can cause rapid shift acid-base balance towards alkalosis and provoke an attack of convulsions.
In the spring, the formation of ergocalciferol in the child’s skin increases, the reabsorption of phosphates increases, calcium is deposited, and in a child with impaired mineral metabolism and against the background of ergocalciferol deficiency, hypocalcemia may occur.
Play a certain role in the pathogenesis of spasmophilia parathyroid glands, whose function is increased in hypovitaminosis D. At advanced education Ergocalciferol may cause hypofunction of the parathyroid glands, which leads to hypocalcemia.

Spasmophilia Clinic

By clinical course There are latent (hidden) and overt (manifest) forms of spasmophilia. Latent spasmophilia precedes overt spasmophilia and can last from several weeks to several months. Under the influence of provoking moments, latent spasmophilia can turn into overt spasmophilia.
Latent spasmophilia is characterized by the following symptoms.
Chvostek's sign- when lightly tapping the cheek with a finger in the fossae caninae area, the facial muscles of the corresponding side contract.
Trousseau's sign. When the neurovascular bundle of the shoulder is compressed, after 3-5 minutes the hand contracts convulsively - “the hand of the obstetrician.”
Erb's sign more permanent. Irritation median nerve in the elbow bend, galvanic current causes contraction at a current strength of less than 5 mA (normally more than 5 mA).
The Maslov phenomenon. Under the influence of painful stimulation by an injection, a short-term cessation of breathing occurs, which is not observed in healthy child.
With spasmophilia, signs of rickets are usually determined: tachycardia, angiospastic phenomena, excessive sweating and dysfunction of the alimentary canal. There is a dysfunction of the central nervous system - children are fearful, restless, and sleep anxiously.
Explicit spasmophilia occurs against the background of a latent course, sometimes quite suddenly and manifests itself as laryngospasm, carpopedal spasms and an attack of eclampsia.
Laryngospasm occurs paroxysmally in the form of a slight spasm of the glottis or its complete, but short-term closure. Cyanosis and bulging eyes appear, the child becomes frightened and becomes covered in sticky sweat. Following the spasm comes a noisy inhalation - a “crow of a cock.” An attack can last from a few seconds to 1 - 2 minutes and repeat throughout the day.
Carpopedal spasm- tonic contraction of the muscles of the feet and hands. It can last for hours, sometimes for several days. The hands are bent as much as possible, thumb brought to the palm, in the metacarpophalangeal joints the fingers are bent at a right angle, in the interphalangeal joints they are straightened (“obstetrician’s hand”). The feet are in a state of sharp plantar flexion. With prolonged spasm, swelling may appear on the dorsum of the feet and hands. There is no pain.
Tonic facial spasms create the impression of a mask. There may be spasms - convulsions of involuntary muscles: disorders of urination, defecation. Bronchospasm is especially dangerous. The most severe manifestation of overt tetany is eclampsia - a general attack of tonic-clonic convulsions with loss of consciousness. In mild cases, the attack may be limited by the child's pallor, numbness, lethargy, and twitching of the facial muscles. A severe attack often begins with twitching of the facial muscles. Then the spasms spread to other muscle groups, affecting the respiratory muscles. Breathing becomes intermittent, sobbing, and cyanosis appears. The child loses consciousness and appears involuntary urination and defecation. After an attack, the child usually falls asleep. The duration of the attack is from a few seconds to 20 - 30 minutes. Frequently recurring attacks can create a picture of status eclampticus.
In children of the first half of the year, laryngospasm and attacks of general convulsions are more often observed, and at the age of one year - carpopedal spasm. At untimely treatment spasmophilia can recur.

Prognosis of spasmophilia

The prognosis is favorable in most cases. The danger for the child is an attack of general tonic convulsions, during which respiratory arrest and weakness of cardiac activity may occur.

Treatment of spasmophilia

Infants should limit cow's milk whenever possible.
For general convulsions, chloral hydrate is used in an enema (0.1 - 0.3 g in the first half of life and 0.3 - 0.5 g in the second, per 30 - 50 g of water); 25% solution of magnesium sulfate (0.2 ml/kg) intramuscularly. If these measures are ineffective, sodium hydroxybutyrate (GHB) is administered slowly intravenously (50 - 120 mg/kg in a 20% solution). The drug causes a state closest to natural sleep, but often depresses breathing.
In case of laryngospasm, the child is carried out to Fresh air, sprinkle with cold water, irritate the root of the tongue.
In all forms of spasmophilia, it is pathogenetically justified to prescribe calcium supplements to increase the content of its ionized part in the blood. Apply 10% ammonium chloride solution in a teaspoon or dessert spoon 3 - 4 times a day, 10% calcium chloride solution in 1 dessert spoon 3 times a day for 2 - 3 weeks. All these remedies are symptomatic.
Antirachitic treatment begins 2 to 3 days after the prescription of calcium supplements.
Prevention of spasmophilia identical to the prevention of rickets. Special meaning It has natural feeding child.

) - This pathological condition, characterized by increased 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 due to a violation of calcium-phosphorus metabolism in the child’s body (a drop in calcium levels in the blood). There are hidden (latent) and overt (manifest) forms of spasmophilia. Hidden spasmophilia sometimes becomes obvious if the child receives small doses of vitamin D; the disease is in a certain connection with rickets (see).

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

Chvostek's sign (facial phenomenon) - when you lightly tap 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.” Lyust phenomenon - when tapping below the head, little tibia there is 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 is accompanied by muscle contraction and flexion of the fingers.

Explicit spasmophilia manifests itself in the form of laryngospasm - a spasm of the glottis, which sometimes occurs during the screaming and crying of a child; laryngospasm is manifested by difficulty breathing (inhalation), sometimes stopping breathing; Repeated attacks may occur during the day. Less common are carpopedal (“obstetrician’s hand”) and seizures of facial facial muscles. The most severe form of spasmophilia occurs in the form and manifests itself as general clonic convulsions with loss of consciousness. Convulsive contractions of the heart muscle are observed with possible cardiac arrest and sudden death. Outside of attacks, increased neuromuscular excitability and positive symptoms of Khvostek, Trousseau, and Lyust remain. An obvious form of spasmophilia can last from several days to 2-3 weeks.

The diagnosis is made based on the listed symptoms and biochemical data. It is important to promptly identify the hidden form of spasmophilia.

Spasmophilia (Greek spasmos - spasm, cramp and philia - predisposition, tendency; rachitic tetany) - a disease of children mainly early age, characterized by a tendency to tonic and tonic-clonic convulsions and manifestations of increased neuromuscular excitability due to a decrease in the level of ionized calcium in the extracellular fluid. This often occurs against the background of alkalosis.

Symptoms

There are hidden (latent) and overt spasmophilia, differing from each other in the degree of severity of the same pathological process. The disease is most often observed in the spring during the period of recovery from rickets.

At hidden form children are practically healthy in appearance, often normally, and sometimes excessively well-fed, psychomotor development is within normal limits; they almost always have symptoms of rickets, most often during the repair period. You can suspect hidden (latent) spasmophilia in a child by the presence of signs of hyperexcitability - restlessness, trembling, hyperesthesia.

Most frequent symptoms are: facial Khvostek phenomenon (with tapping in front of the ear, in the area of distribution facial nerve, lightning-fast contractions of the facial muscles appear in the mouth, nose, lower, and sometimes upper eyelid); Trousseau phenomenon (when the shoulder is compressed with an elastic tourniquet for 3 minutes, a convulsive contraction of the fingers occurs in the form of an “obstetrician’s hand”); Maslov's symptom (with a slight prick of the skin of a child with spasmophilia, breathing stops at the height of inspiration; in a healthy child, such irritation causes an increase in frequency and deepening breathing movements; this phenomenon is clearly visible on the pneumogram); peroneus phenomenon (rapid abduction of the foot upon impact below the head of the fibula in the area of the fibularis superficialis).

With obvious spasmophilia in a child, most often when crying or frightened, laryngospasm occurs - spasm of the glottis. It manifests itself with a loud or hoarse inhalation during crying and screaming and a cessation of breathing for a few seconds: at this moment the child first turns pale, then he develops cyanosis, loss of consciousness, and sometimes joins clonic seizures. The attack ends with a deep, sonorous breath, after which the child almost always cries, but after a few minutes he returns to normal and often falls asleep, with swelling of the back of the hands often appearing. Less often, breathing stops not on inhalation, but on exhalation. In the most severe cases, death may result from sudden cardiac arrest (tetany).

Carpopedal spasm is a spasm of the distal muscles of the hand and foot, taking a characteristic position (the hand is in the “obstetrician’s hand” position, the foot is in the position of the equine foot (stable plantar flexion, especially thumbs). This condition of the hands and feet can be short-lived, but can persist for a long time, for several hours or even days; with spasm m. orbicularis oris the lips take the position of a “fish mouth”.

In the most severe cases, attacks of eclampsia are observed - clonic-tonic convulsions, occurring with loss of consciousness. They occur after short-term tonic convulsions. Eclamptic convulsions may be prolonged or interrupted for a short time. Sometimes, as already mentioned, clonic convulsions are associated with an attack of laryngospasm.

Diagnostics

Diagnosis does not present significant difficulties. The presence in a child aged 4-18 months of clinical, biochemical and radiological data indicating rickets, and symptoms of increased neuromuscular excitability make it mild. Typical attack laryngospasm almost always allows us to consider the diagnosis indisputable. ECG data indicate hypocalcemia (increased Q-T complex more than 0.3 s).

All patients have a decrease in the concentration of ionized calcium in the blood serum (below 0.85 mmol/l when the norm is 1.0-1.4 mmol/l) in combination with alkalosis (respiratory, less often metabolic). Reduced concentration total calcium in blood serum (less than 1.75 mmol/l with a norm of 2.5-2.7 mmol/l) is less common than low level ionized calcium.

Spasmophilia is differentiated from diseases that can cause tetany, seizure attack.

For hypoparathyroidism, which is very rare in infants, characterized by severe hypocalcemia and hyperphosphatemia. In renal osteodystrophy, a decrease in serum calcium occurs against the background of acidosis, hyperphosphatemia, azotemia and other manifestations of chronic renal failure. Transfusion of a large amount of blood stabilized with citrate in a hospital can lead to the binding of calcium in the blood, which, against the background of hyperkalemia, explains the attack of seizures. Tetany can also be a consequence of hypomagnesemia.

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

Treatment

With laryngospasm, a dominant focus of excitation is created in the brain by irritating the nasal mucosa (blowing into the nose, tickling, bringing ammonia), skin (injection, patting and pouring cold water on the face), vestibular analyzer (“shaking” the child), changes in body position. For convulsions, administer intramuscularly seduxen(0.1 ml of 0.5% solution per 1 kg of body weight) or magnesium sulfate(0.5 ml/kg 25% solution), GHB(0.5 ml/kg 20% solution) and always at the same time - intravenously calcium gluconate(1-2 ml/kg of 10% solution), oxygen inhalation is performed. The child is hospitalized after the seizures disappear.

It is advisable to transfer a bottle-fed baby to feeding with expressed milk from a donor. 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 large quantity phosphates) and increase the amount of vegetable complementary foods.

In infants, the calcium requirement is 50-55 mg/kg per day. 10% solutions of calcium gluconate and chloride contain 9 mg and 36 mg of calcium in 1 ml, respectively. Calcium lactate contains 13% calcium ion. Calcium preparations include 5% calcium gluconate solution, calcium lactate and 1-2% calcium chloride solution with milk. The use of more concentrated solutions of calcium chloride for oral administration can cause severe irritation of the gastric mucosa and even ulceration. It is appropriate to recall here that rapid intravenous administration of calcium supplements can cause bradycardia and even cardiac arrest.

3-4 days after seizures, patients with obvious spasmophilia should be prescribed vitamin D 3 2000-4000 IU 2 times a day; against the background of intensive calcium therapy, 40,000-60,000 IU of vitamin D can be prescribed simultaneously. The method of choice may also be the administration of a 0.1% dihydrotachysterol solution orally at 0.05-0.1 mg/day (1-2 drops 2 times). While having a positive effect on 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 symptoms disappear completely. latent spasmophilia. It is necessary to limit as much as possible or perform very carefully all procedures that are unpleasant for the child (examination of the pharynx, injections, etc.) that can cause severe attack laryngospasm.

Prevention

Basically the same as with rickets. It is necessary to strive to preserve breastfeeding as much as possible. In spring, when symptoms appear latent spasmophilia calcium supplements should be prescribed.

Forecast

The prognosis is favorable. Very rarely, a severe attack of laryngospasm (if not treated urgent Care) ends fatally. A very prolonged eclamptic state can negatively affect the central nervous system - in the future there may be a delay in mental development.