Tetany: types, causes and treatment methods. Hidden tetany Neurogenic tetany

Tetany is a clinical syndrome in which the central place is occupied by a state of increased excitability of the neuromuscular system, expressed in a tendency to convulsions. According to the clinical course, there are obvious and hidden forms of tetany. With obvious tetany, convulsions occur spontaneously. They are usually preceded by paresthesia. Convulsions are tonic in nature, accompanied by severe pain and occur either in the form of successive mild and short-lived attacks, separated from one another by more or less long periods of time, or in the form of very prolonged severe convulsive states. Mild degrees - the so-called latent (hidden) tetany - can occur without any visible external manifestations, or patients feel only paresthesia in the limbs, a feeling of spasms, coldness, “crawling goosebumps”, not accompanied by convulsions. Hidden forms of tetany under the influence of certain factors, such as: hyperventilation, infections, pregnancy, intoxication, etc., can develop into an overt form of the disease, manifesting itself in attacks of convulsions. With a sufficiently pronounced tendency to convulsions, the latter in a patient can easily be caused by one or another strong irritation: mechanical, painful, thermal, etc.

For convulsions during tetany, a selective nature is typical. They spread to certain muscle groups symmetrically on both sides. Most often, the muscles of the upper extremities are involved, somewhat less frequently - the muscles of the lower extremities. Often, in severe forms of the disease, cramps of the facial muscles are observed, much less often - of the torso, abdominal obstruction, and only in exceptional cases (mainly in children) do they spread to the muscles of the internal organs (larynx, stomach). In the extremities, spasms spread mainly to the flexor muscle groups, which is why during attacks the limbs take on a peculiar position, typical of tetany. With cramps of the upper extremities, the shoulder is slightly brought towards the body, the forearm is bent at the elbow joint, the hand is bent at the radiocarpal and metacarpal joints, the fingers are clenched and slightly inclined towards the palm. The position of the hand and fingers during an attack of convulsions is called the “obstetrician’s hands” due to some similarity with the position of the hand of a doctor ready to begin a gynecological examination.

With cramps of the lower extremities, the foot is curved inward, the toes are in a plantar flexion position, the big toe is covered with the rest and the sole is depressed in the form of a groove. Due to the convulsive contraction of the adductors, the legs are closely pressed against each other in an extended position.

The spasm of the facial muscles gives it a characteristic expression: the mouth takes on the appearance of a so-called fish mouth. The eyelids are half-lowered, the eyebrows are knitted. During convulsions, voluntary movements of the affected muscles become impossible for the patient. Contracted muscles are hard, difficult to stretch, and when the stretching stops, they return to their previous position. An attempt to stretch the cramped limbs sharply increases the pain experienced by the patient. When convulsions spread to the muscles of the body (which is observed quite rarely), due to convulsive contraction of the intercostal muscles, abdominal muscles and diaphragm, severe respiratory distress is noted. Sometimes rigidity of the spine occurs, and when the neck and spinal muscles spasm, the spine bends backward. The spread of spasms to the muscles of the larynx leads to spasm of the glottis (laryngospasm). Laryngospasm is rare in adults; in children, it is a frequent manifestation of tetany, and can occur independently of general widespread convulsions. With laryngospasm, inspiratory shortness of breath of greater or lesser intensity is observed, breathing becomes noisy, the face is cyanotic, and foam appears on the lips. In severe cases, the patient loses consciousness. A prolonged attack with delayed medical care (intubation, tracheotomy) can be fatal.

Attacks of convulsions during tetany occur both spontaneously and in connection with certain physical irritations: bruises, muscle tension, stretching of limbs, overheating of the body (for example, a hot bath) can also contribute to the occurrence of an attack.

A number of symptoms characteristic of tetany are based on the increased excitability of motor nerve trunks, which make it possible to identify the disease outside of attacks and contribute to the diagnosis of a latent form of the disease.

Chvostek's sign

Chvostek's sign (or "facial nerve phenomenon") is caused by tapping with a percussion hammer or finger on the trunk of the facial nerve at its exit near the external auditory canal, after which the patient with tetany experiences contraction of the corresponding side of the facial muscles.

There are three degrees of symptoms:

“Tail I” - when the muscles of the entire area innervated by the facial nerve contract;

“Tail II” - the muscles in the area of the wing of the nose and the corner of the mouth contract;

“Tail III” - only the muscles of the corner of the mouth contract.

Only “Khvostek I” has unconditional diagnostic value. With obvious tetany, it is clearly expressed even with a light touch in the area of the facial nerve trunk. “Khvostek II” and “Khvostek III” are always positive in cases of latent hypoparathyroidism, but their diagnostic value is low, since they can be positive in other diseases not associated with hypoparathyroidism: neurasthenia, hysteria, asthenia, exhaustion, etc.

Weiss's sign

Diagnostically less reliable and inconsistent is the Weiss symptom, which consists in the fact that when tapping at the outer edge of the orbit (along the superior branch of the facial nerve), a contraction of the round muscles of the eyelids and frontal muscles occurs.

Trousseau's sign

The next symptom, the presence of which always indicates tetany, but the absence does not yet exclude the latent form of the latter, is Trousseau's symptom. It is installed by tightly tightening (until the pulse disappears) the shoulder with a tourniquet or rubber cuff of a device for measuring blood pressure. With a positive Trousseau's symptom, after 2-3 minutes, and sometimes almost immediately, a typical tetanic contraction of the hand occurs in the overstretched hand with its position in the form of an “obstetrician’s hand”; the appearance of cramps is preceded by a feeling of numbness and pain in the fingers.

Schlesinger's symptom

With rapid passive flexion of the patient's leg at the hip joint, straightened at the knee joint, a cramp appears in the extensor muscles of the thigh with simultaneous sharp supination of the foot - Schlesinger's symptom. To identify this symptom, the patient should be placed on his back.

Erb's sign

The state of motor nerves during tetany, in addition to increased mechanical excitability, is also characterized by a sharp increase in their electrical excitability. Erb's symptom is based on this: with a galvanic current of even very low strength (not higher than 0.7 ta), a cathode-closing contraction occurs, which, with a slight increase in the current, turns into cathode-closing tetanus. The study is usually performed on the ulnar or peroneal nerve.

Hoffmann's sign

With tetany, an increase in mechanical and electrical excitability is characteristic not only of motor nerves, but also of sensory nerves. Even light pressure on the nerve causes parasthesia, spreading to the area of branching of this nerve, while normally pressure causes only a local sensation. This symptom is called Hoffmann's symptom.

Autonomic nervous system with tetany

The autonomic nervous system in patients with tetany is in a state of increased excitability, clinically expressed in the patients' tendency to sweating, tachycardia and vasomotor phenomena. Most patients have an increased reaction to the administration of adrenaline and pilocarpine. However, in some cases the response to these pharmacological stimuli may be reduced.

Changes in the respiratory system during tetany

On the part of the respiratory system during tetany, no permanent changes are detected, except for the spasm of the glottis described below in severe forms of tetany, mainly in childhood.

Changes in the cardiovascular system during tetany

The cardiovascular system reflects increased excitability of the autonomic nervous system.

A characteristic electrocardiographic symptom of tetany is an increase in the Q - T interval, mainly due to an increase in the S - T interval, which is caused by hypocalcemia, the elimination of which by intravenous infusion of calcium leads to the normal value of the indicated interval.

Changes in the gastrointestinal tract with tetany

The function of the gastrointestinal tract in patients with tetany is often impaired, and there are both secretory (gastrosucorrhoea, hyperchlorhydria) and motor (pylorospasm, diarrhea) disorders. Sometimes these disorders are concomitant, secondary. In some cases, they are primary, and tetany develops due to these disorders (gastric and intestinal forms of tetany).

Changes in the skeletal system during tetany

On the part of the skeletal system in patients with tetany, no noticeable deviations from the norm can be detected.

Changes in the psyche with tetany

The psyche of patients with tetany is usually not changed. Only in rare cases were combinations with psychoses noted - a manic state and increased mental excitability. Often patients have a tendency to neurasthenic and hysterical reactions, and thus mixed forms of hysteria and tetany arise.

It should be noted that there are frequent cases of combination of tetany with epilepsy. Obviously, the same conditions that create a state of increased excitability of the nerve trunks also contribute to a decrease in the “convulsive tolerance” of the cells of the cerebral cortex. When tetany is combined with epilepsy, a decrease in intelligence can be observed.

Tetany: symptoms and treatment

Tetany - main symptoms:

Convulsions
Speech Impairment
Sweating
Suffocation
Numbness of the limbs
Rapid breathing
Pale skin
Creepy crawling sensation
Muscle spasm of the lower extremities
Arm muscle spasm
Tingling in the limbs
Blurred vision

Tetany is a clinical syndrome during which neuromuscular excitability occurs. It may manifest itself as a result of metabolic disorders and a decrease in ionized calcium in the blood. Most often, this syndrome manifests itself as cramps in the muscles of the limbs and face. In some cases, it may manifest itself as convulsions in the heart muscles, which can lead to cardiac arrest.

Sometimes the syndrome occurs in newborns and disappears after approximately 21 days. During this syndrome, pregnant women may experience uterine tetany, which significantly complicates childbirth.

Clinicians identify many reasons that can cause this syndrome. Often, tetanic muscle contraction occurs due to a decrease in calcium in the blood. The cause of this syndrome is sometimes a dysfunction of the parathyroid glands.

Tetanic convulsions can also be caused by the following etiological factors:

stomach disease;
endocrine pathologies;
various injuries that caused hemorrhages in the parathyroid glands;
dehydration due to frequent vomiting and loose stools;
hyperparathyroidism of parathyroid adenoma;
nervous tension and stress;
violation of acid-base balance;
congenital pathologies of the parathyroid gland.

Often, tetany may occur after surgery.

In newborns, the syndrome may occur due to the fact that the supply of calcium from the mother stops (hypocalcemic tetany).

Failures in the balance of microelements can lead to the patient developing neurogenic tetany.

In pregnant women, this syndrome can occur if there is a disruption in the functioning of the parathyroid gland. Uterine tetany can be caused by the following reasons:

severe stress;
inflammation and pathological changes in the uterus;
scarring on the uterus;
endocrine and metabolic disorders;
tumor of the pelvic organs or narrow pelvis.

Classification

Clinicians identify the following forms of this pathological process:

neurogenic (manifests itself as a result of a hyperventilation crisis);
enterogenous (caused by impaired absorption of calcium in the intestine);
hyperventilation;
hypocalcemic;
latent tetany;
gastrogenic;
pasture;
tetany of pregnant women.

There is also neonatal tetany, which is divided into early and late neonatal hypocalcemia.

Symptoms

The symptoms of this syndrome depend on its type. Since there are several forms of this syndrome, the clinical picture may vary. However, the following general symptoms of this process can be identified:

tingling;
numbness of the limbs;
crawling sensation;
muscle spasms;
convulsive contractions;
rapid breathing;
speech disorder;
pale skin;
muscle spasm of the arms and legs;
feeling of suffocation;
increased sweating;
blurred vision.

Diagnostics

In order to accurately diagnose tetany syndrome, the following diagnostic procedures are performed:

tapping the nerve endings of the limbs and facial nerve with a hammer;
pass galvanic current through the peroneal nerve and elbow joint;
tighten the limbs of the arms or legs with a rubber band. When carrying out this method, cramping of the hand, numbness of the limb, or painful sensations may occur. Such manifestations are evidence of the presence of this syndrome.

Also, to identify tetany, you need to put the patient on his back and begin to bend his leg at the hip joint. A cramp in the hip flexor muscle will indicate the presence of this disease.

Sometimes an electrocardiogram can help identify the disease. Based on its curve, one can determine a type of syndrome called latent tetany.

As a rule, treatment of tetany is aimed at eliminating seizures and preventing their occurrence.

Drug therapy includes medications that contain vitamin D. These medications include:

Ergocalciferol;
Videohol;
Dihydrotachysterol.

Medicines that contain calcium are also prescribed. Such medications are considered the most effective in treating tetany.

Avoid foods and supplements that contain phosphorus, as they interfere with calcium production.

Often, for treatment, the following solutions are administered intravenously to the patient:

calcium chloride;
magnesium sulfate;
calcium gluconate.

Sedatives are also prescribed, which reduce emotional stress and act as a sedative.

With this syndrome, diet is mandatory. The patient's diet should contain foods rich in calcium. However, you should reduce your intake of dairy products. Although they contain calcium, they also contain a lot of phosphorus.

Often, the patient is prescribed water procedures, which well complement the treatment of tetany syndrome.

With uterine tetany, independent labor is impossible, so a caesarean section is performed.

Possible complications

Tetany syndrome can cause the development of serious pathological processes in the following body systems:

the cardiovascular system;
gastrointestinal tract.

Also affected by this syndrome is the autonomic nervous system, which during illness is in a state of increased excitability, which can lead to complications.

In some cases, tetany can affect the patient's mental state, which is manifested by neurasthenic or hysterical reactions.

Prevention

There are no specific preventive measures against this syndrome. The risk of developing such a pathological process can be reduced if you adhere to the rules of a healthy lifestyle and undergo regular medical examinations.

In most cases, the prognosis for patients with tetany is favorable. The main thing is to start treating this disease on time. Laryngospasms that occur during attacks can pose a threat to the patient. However, the prognosis is unfavorable for those patients who have concomitant diseases of the gastrointestinal tract and cardiovascular system.

If you think that you have Tetany and the symptoms characteristic of this disease, then a general practitioner can help you.

We also suggest using our online disease diagnostic service, which selects probable diseases based on the entered symptoms.

Caisson disease is a pathological condition that progresses due to a person’s transition from an area with elevated atmospheric pressure to an area with normal levels. The disorder gets its name from the process of transition from high blood pressure to normal. Divers and miners who spend a long time at depth are often susceptible to this disorder.

Hypoparathyroidism is a disease caused by insufficient production of parathyroid hormone. As a result of the progression of the pathology, a violation of calcium absorption in the gastrointestinal tract is observed. Hypoparathyroidism without proper treatment can lead to disability.

Neuropathy is a disease characterized by degenerative-dystrophic damage to nerve fibers. With this disease, not only peripheral nerves are affected, but also cranial nerves. Often there is inflammation of a single nerve; in such cases, this disorder is called mononeuropathy, and when several nerves are affected simultaneously, it is called polyneuropathy. The frequency of manifestation depends on the causes of occurrence.

Diabetic neuropathy is a consequence of ignoring symptoms or lack of treatment to control diabetes. There are several predisposing factors for the appearance of such a disorder against the background of the underlying disease. The main ones are addiction to bad habits and high blood pressure.

Diabetic polyneuropathy manifests itself as a complication of diabetes mellitus. The disease is based on damage to the patient’s nervous system. Often, the disease develops in people 15–20 years after diabetes developed. The incidence of progression of the disease to a complicated stage is 40–60%. The disease can occur in people with both type 1 and type 2 disease.

With the help of exercise and abstinence, most people can do without medicine.

Tetany- convulsive syndrome and increased neuromuscular excitability caused by impaired calcium metabolism in the body.

Causes of tetany

Tetany occurs due to insufficient function of the parathyroid glands.

The disease can occur as a result of injury, inflammatory and infectious processes in the area of the parathyroid glands, as well as during surgical removal of the glands.

Types of tetany

Main types of tetany- gastrogenic tetany and neurogenic tetany syndrome.

Neurogenic tetany is characterized by a negative effect on the autonomic nervous system, and gastrogenic tetany is characterized by disturbances in the digestive system.

The disease often occurs in conjunction with epilepsy, neurasthenic and hysterical reactions, manic psychoses and increased mental excitability.

Symptoms of tetany

Tetany is characterized by symptoms such as:
Attacks of tonic muscle spasms, accompanied by painful sensations;v Facial muscle spasms;
Convulsive contractions of the respiratory muscles;
Loss of consciousness;
Arching of the body backwards when spasms spread to the back muscles.

With prolonged tetany, the patient develops cataracts, and tooth enamel defects become chronic. Chronic excessive hair loss on the scalp also occurs.

For neurogenic tetany characterized by laryngospasm, during a severe attack of which life-threatening asphyxia may occur.

Treatment of tetany

Treatment of tetany comes down to eliminating hypocalcemia (lack of calcium in the body). Drug therapy with calcium preparations is carried out.

During an attack The patient is injected intravenously with a 10% calcium chloride solution in a dose of 10 ml. At the same time, 1-3 ml of parathyroidism is injected intramuscularly. The attack is eliminated.

Outside of an attack, the patient needs to take calcium supplements. A diet rich in calcium is prescribed, while phosphorus-containing foods should be limited.

The quantity of animal products is limited. Also appointed taking vitamin D.

When treating tetany, it is necessary to control the level of calcium in the blood.

Tetany: types, causes and treatment methods

The term “tetany” refers to convulsions that occur due to a disturbance in calcium metabolism in the human body (see figure). They can be explicit and latent (hidden). In the first case, during prolonged muscle contractions that occur voluntarily, a person experiences pain, and before this he notes a sensitivity disorder. In the case of a latent form of tetany, a person feels spasms in the arms or legs, his limbs become cold, and goosebumps begin to run throughout his body.

A feature of the pathology is that cramps occur only in one muscle group, but without fail on both sides, that is, symmetrically.

The presence of tetany can be determined by several signs. For example, according to Chvostek's symptom, when tapping with a finger or a special hammer along the facial nerve leads to contraction of this entire area.

To identify the Weiss symptom, tapping is done on the outer edge of the eye, which leads to muscle contraction of the eyelids and forehead.

If, while inflating the cuff to determine blood pressure, the fingers begin to cramp, this is also a sign of tetany (Trousseau's sign).

Schlesinger's symptom: if you bend your leg while lying down, a cramp begins in the extensor muscles.

Hoffmann's sign is detected by light pressure on the area of the nerve, which causes tingling, goosebumps, and numbness.

Doctors also perform an electromyographic test for latent tetany.

Treatment of tetany

The essence of treatment is to stop the convulsive state and prevent its further occurrence with the help of calcium-containing drugs.

Neurogenic tetany

One type of tetany is neurogenic tetany. It is characterized by problems with sensitivity (numbness, tingling, burning), muscle spasms, tonic contraction of the arm muscles, carpopedal spasms (tonic contraction of the muscles of the feet and hands). In addition, neurogenic tetany syndrome is expressed in rapid heartbeat, increased excitability and a tendency to sweat.

To eliminate this syndrome, the doctor introduces a certain dose of parathyroid hormone into the human body. But long-term use of this drug causes addiction in the patient, as a result of which the treatment becomes ineffective.

Tetany in children

Children also suffer from tetany. Infantile tetany (or spasmophilia) is characterized by laryngospasm. In the event of a severe attack, life-threatening asphyxia can occur. Seizures in children are the most common occurrence compared to adults. Before the age of two, tetany complications are common. This is associated with pathological disorders that occur during pregnancy and childbirth.

Tetany of pregnant women

This is a form of toxicosis that is quite rare. Most often it manifests itself in the spring and occurs due to a malfunction of the parathyroid glands. Typically, cramps occur in the arms, less often in the legs. Sometimes the face cramps, which can cause speech problems.

The greatest danger is posed by heart muscle convulsions, as this can lead to death. If the muscles of the intestines and stomach cramp, there is non-stop vomiting, and sometimes diarrhea and constipation. In addition, convulsive seizures are possible in pregnant women. In exceptional cases, convulsions cover the entire body, with women losing consciousness and biting their tongues.

Diagnostic data indicate low blood levels of calcium and high concentrations of inorganic phosphorus. The calcium content in urine is also reduced.

If tetany occurs in women during pregnancy, it is necessary to interrupt it both in the early and late stages. To eliminate tetany, parathyroidin, calcium preparations, and vitamin D are prescribed. Calcium-containing preparations not only eliminate attacks of tetany, but also prevent their occurrence in the future. But you need to know that the use of calcium hyperphosphate and other phosphorus-based compounds is prohibited in this case, since an increase in the level of phosphorus in the blood slows down the release of calcium into the blood. A special diet and water procedures are recommended in this case as additional measures.

Tetany uterus

Uterine tetany is a deviation of labor, accompanied by constant tonic tension of this organ. As a result, the parts of the uterus do not contract simultaneously, which causes labor to slow down and stop.

The causes of this anomaly may be endocrine system disorders; nervous stress; overdistension of the uterus due to multiple pregnancy, polyhydramnios or a large fetus; pathological changes in this organ caused by inflammatory processes, uterine malformations, uterine fibroids; obstacles that interfere with the dilation of the cervix and the movement of the fetus (narrow pelvis, neoplasms of the pelvic organs, cicatricial changes in the cervix); incorrect use of drugs that affect the tone of the uterus. In addition, the reasons for the development of tetany include a certain age of pregnant women: before 17 and after 30 years.

During diagnosis, the doctor focuses on the patient’s complaints, medical history, performs palpation, examination of the vagina, cardiotocography, and listens to the fetal heartbeat.

To treat uterine tetany, doctors use anesthesia to help restore labor. If the birth of a child naturally is not possible, a caesarean section is performed. If the cervix is completely dilated, the fetus is removed using obstetric forceps or by the stem.

Parathyroid tetany

Parathyroid tetany is a fairly rare but very serious complication that occurs after strumectomy (removal of the thyroid gland in full or in part). It is associated with a sharp decrease in the concentration of calcium in the blood and an increase in the concentration of potassium ions and inorganic phosphorus.

During an acute attack, convulsions of the upper and lower extremities are most often observed, and less often - of the muscles of the face and torso. One of the first symptoms of parathyroid tetany is hypocalcemia.

With the development of parathyroid tetany after strumectomy, it is recommended to administer 10–20 ml of a 10% calcium chloride solution intravenously, 2–3 times a day in the case of an acute course of the disease; in a subacute course, the number of injections is reduced. In addition, 5–10% solutions of calcium chloride (in the form of a mixture) are prescribed 3 times a day, one tablespoon.

Hypocalcemic tetany

A decrease in the production of parathyroid hormone leads to a decrease in the production of phosphorus by the kidneys, which is why its concentration in the blood increases. Less and less phosphorus is used from bones, which means less calcium is also released, and the body no longer has enough of it.

Gastrogenic tetany

This type of tetany is a serious complication of peptic ulcer disease. Since practicing doctors do not often encounter this disease, it is often diagnosed very late, and therefore the outcome of treatment is not always positive.

Natekal D3 in the treatment of latent tetany associated with psychovegetative syndrome.

MMA im. THEM. Sechenov, Department of Nervous Diseases, Faculty of Physical Education, Central Clinical Military Hospital of the Federal Security Service of the Russian Federation
prof. Vorobyova O.V., Popova E.V., Ph.D. Kuzmenko V.A.

Hyperventilation disorders are extremely common in the clinical structure of autonomic dysfunction that accompanies various neurotic or stress-dependent disorders. The importance of diagnosis and treatment of hyperventilation syndrome (HVS) is primarily determined by its direct participation in the pathogenesis and symptom formation of many clinical manifestations of psychovegetative syndrome. The symptom-forming factor of HVS is realized through the mechanisms of hypocapnia and related processes, including those leading to tetany. In classical descriptions of hyperventilation syndrome (1), a triad of signs has always been distinguished:

increased breathing,

paresthesia,

tetany.

The presence of tetanic symptoms in the structure of the HVS is considered a highly pathognomonic diagnostic sign (2). Symptoms of neurogenic tetany tend to persist and are difficult to treat with psychotropic drugs. Even after successful treatment of psychovegetative syndrome, many patients retain symptoms of tetany, which makes remission incomplete. Probably, tetanic symptoms of unknown origin for the patient and hypochondriacal fixation on them, forming a “vicious circle”, aggravate anxiety, chronicizing the neurotic disease. Therefore, the treatment of latent tetany is as urgent a task as the actual therapeutic effect on the HVS.

Vivid tetanic manifestations within the framework of HVS, such as carpopedal spasms, occur infrequently, in approximately 1-5% of cases. But this is just the tip of the iceberg, which far from exhausts all manifestations of tetany within the framework of hot water supply. Hidden or latent tetany is the main underwater part of the iceberg.

Clinical manifestations latent tetany are presented in Table 1.

Table 1. Clinical and paraclinical manifestations of neurogenic tetany.

Paresthesia
Painful muscle tension
Convulsive muscle-tonic phenomena
Clinical correlates of neuromuscular excitability (positive Chvostek’s sign, Trousseau-Bonsdorff test)
EMG correlates of neuromuscular excitability

There are many symptoms and clinical signs of latent tetany, but no specific symptoms, so the diagnosis is often difficult (3). Diagnosis should be based on a combination of symptoms. The most common manifestations of hidden tetany are paresthesia. Sensory disturbances (numbness, tingling, a feeling of “crawling”, buzzing, burning) and pain are characterized by spontaneity of occurrence and short duration, predominant involvement of the hands, and a centropetal type of distribution. Most often, sensory disorders are symmetrical. As a rule, paresthesia precedes the appearance of muscle spasms.

Muscle cramps that follow paresthesia involve the muscles of the hands (“obstetrician’s hand”) and feet (carpopedal spasms), starting in most cases from the upper extremities. But more often, patients complain of painful sensations in individual muscles (for example, cramps), which are provoked by physical activity, thermal effects (cold water) or occur during voluntary extension of a limb.

Neuromuscular excitability (NME) is tested clinically and electromyographically. The most informative clinical tests are Chvostek's symptom (percussion with a neurological hammer of the buccal muscle in the area of passage of the facial nerve) and Trousseau's test (ischemic cuff test). Trousseau's test is less sensitive than Chvostek's sign, but its sensitivity increases when a hyperventilation load is performed at 10 minutes of ischemia (Bonsdorff test). The electromyogram (EMG) demonstrates spontaneous autorhythmic activity containing doublets, triplets, and multiplets that occur within short time intervals during provocative tests (Trousseau test, hyperventilation load).

Hyperventilation tetany is considered normocalcemic, although approximately one third of patients have hypocalcemia (4). Voluntary hyperventilation can lead to significant changes in ionized calcium levels in healthy individuals. At the same time, studies using radioisotope methods made it possible to establish the existence of deep anomalies in calcium metabolism, mainly associated with a decrease in the “total calcium pool” in patients with tetany.

Pathogenetically calcium imbalance and hyperventilatory tetany proper are associated with respiratory alkalosis. Hypocapnia and associated respiratory alkalosis are an obligate biochemical phenomenon in HVS. Both alkalosis itself and the large range of biochemical changes associated with it, including calcium metabolism disorders, naturally increase neuromuscular excitability. Theoretically, it is quite tempting to assume that long-term changes in biochemical processes caused by chronic HVS can ultimately lead to an increase in the level of NMV. However, NMV is not an obligate symptom of HVS and is absent in 15-20% of patients with chronic HVS. Probably, for the development of NMV, a constellation of factors is required: “constitutional predisposition” (possibly in the form of features of calcium metabolism) and alkalosis itself caused by HVS. Long-term successful use of calcium supplements for hyperventilation tetany indirectly confirms the pathogenetic participation of calcium metabolism in the genesis of normocalcemic tetany. However, the use of drugs that regulate calcium metabolism in latent tetany is based largely on the clinical experience of doctors. Research studies on the effectiveness of calcium supplements in the treatment of hyperventilation tetany are relatively few.

We conducted an open “pilot” study of the effectiveness of high doses of vitamin-calcium therapy in the treatment of hyperventilation tetany.

Purpose This open comparative study assessed the effectiveness of Natekal D3 in the treatment of latent tetany associated with hyperventilation syndrome. The choice of Natekal D3 was due to the high content of ionized calcium in this drug. One tablet of Natekal D3 contains 400 IU of colecalciferol and 1.5 g of calcium carbonate, which corresponds to the content of 600 mg of ionized calcium. In this study, the following tasks were solved: assessment of the therapeutic effect of the therapy in relation to tetany itself and accompanying syndromes; study of adverse reactions and complications.

To the study turned on patients meeting the following criteria:

The leading complaint is dyspnea, paresthesia and/or muscle spasms of the limbs
positive Chvostek's sign (grades I-III) and Trousseau-Bonsdorff test
presence of an anxiety disorder meeting the ICD-10 criteria for panic disorder or generalized anxiety disorder
patient age over 20 years
absence of current somatic diseases
absence of comorbidity of anxiety disorder with psychotic disorders
patient consent to participate in the study.

Treatment was prescribed after discontinuation of previous therapy for at least 2 weeks. Natecal D3 was prescribed 1 chewable tablet twice a day. The duration of treatment was 4 weeks.

Before prescribing the drug, each patient was subjected to a standard clinical and neurological examination with clinical tests for latent tetany, the degree of autonomic dysfunction and hyperventilation was assessed using questionnaires developed in the Department of Pathology of the Autonomic Nervous System of the MMA (5), mental status was assessed using the Spielberger and Beck Anxiety Questionnaire for depression. The impact of tetanic symptoms on quality of life was also assessed.

After 4 weeks of therapy with Natecal D3, the therapeutic effect was assessed primarily on the severity of tetany, as well as in relation to concomitant syndromes. Tolerability of treatment was determined based on clinical examination, and patient self-reports were also used (the number of serious adverse events, non-serious adverse events was assessed).

The study group consisted of 12 patients (3 men; 9 women) aged 38±4.5 years; all women included in the study were of reproductive age. The majority of patients (70%) were diagnosed with panic disorder; a feature of the panic attacks of these patients were respiratory and tetanic manifestations, which made it possible to discuss hyperventilatory crises. 30% of patients had generalized anxiety disorder or anxiety-depressive disorder.

First of all, we assessed the effect of Natekal D3 on the so-called “tetanic” symptoms: the severity of paresthesia, pain, painful muscle spasms (subscales of the autonomic dystonia questionnaire) (Fig. 1).

Rice. 1 Dynamics of “tetanic symptoms”

After a month of treatment, a significant (p) Clinical correlates of latent tetany (LMT) also underwent a certain regression (Fig. 2). The number of patients with a positive Trousseau-Bonsdorff test (χ2 = 2.9) decreased significantly.

Rice. 2 Trousseau-Bonsdorff test

Some positive trend (p Fig. 3 Dynamics of the intensity of hyperventilation and the total score of vegetative dystonia.

Indicators of the current mental state also improved: the level of anxiety decreased from 37.6±1.3 to 32.2±1.1 (pTolerability of Natekal D3 in the study sample was very good. We did not observe any side effects of the therapy. All patients completed the course of treatment.

The results obtained convincingly demonstrate that the symptoms of latent tetany are partially regressed under the influence of vitamin-calcium therapy. This to a certain extent confirms the complexity of the formation of latent tetany, where calcium metabolism disorders are an important, but not the only mechanism. The insignificant dynamics of the severity of HVS in treated patients indicates the relative independence of HVS and latent tetany and the need for additional influence on HVS. On the other hand, it becomes clear that only influencing hyperventilation without therapeutic consideration of the symptoms of tetany cannot provide complete remission.

The observed improvement in the current mental state in the studied category of patients may be associated with regression of tetanic symptoms, with a placebo effect, or with the actual effect of calcium on the central nervous system. The role of calcium in the central nervous system is multifaceted; for a long time this element was considered as an important component of vegetative-humoral regulation, as “liquid sympatheticus”.

The study showed the usefulness of using drugs that affect calcium metabolism in latent tetany. Of course, vitamin-calcium therapy cannot be considered as the main method of treating HVS. But even partial regression of tetanic symptoms allows one to break the vicious circle of HVS-tetany-HVS.

Natecal D3 can be recommended as an important element in the complex treatment of HVS with latent tetany along with psychotropic therapy and correction of respiratory disorders. Diagnosis and treatment of latent tetany will improve the prognosis of a neurotic disease.

LITERATURE
1. Vein A.M., Moldovanu I.V. Neurogenic hyperventilation. Chisinau "Shtiinta" 1988
2. Moldovanu I.V., Yakhno N.N. Neurogenic tetany. Chisinau “Shtiinta” 1985
3. Torunska K. Tetany as a difficult diagnostic problem in the neurological outpatient department. // Neurol Neurochir Pol. 2003;37(3):653-64
4. Durlach J, Bac P, Durlach V et al. Neurotic, neuromuscular and autonomic nervous form of magnesium imbalance. // Magnes Res 1997;10(2):169-95
5. Autonomic disorders (clinic, diagnosis, treatment) Edited by A.M. Vein MIA Moscow 1998

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Gastrogenic tetany(HT), or chlorhydropenic syndrome, chloropenia, chloroprival uremia, is a very severe complication of ulcer. It occurs quite rarely, mainly with stenosis of the gastric outlet. Despite the sufficient number of clinical studies on this issue, this complication of ulcer is little known to practical doctors, and therefore it is not always diagnosed in a timely manner, and therefore treatment is not carried out fully, and this, as a rule, becomes the reason for its unfavorable outcome. Often, diagnosing HT can be so difficult that, due to a misunderstanding, these patients end up in an infectious diseases hospital, and in some cases, when accompanied by mental disorders, they can even be hospitalized in the neuropsychiatric department.

HT often develops due to ulcer of the pyloroduodenal region against the background of its cicatricial stenosis.
There are three forms of HT: fulminant, true tetanic and latent (V.M. Subbotin et al., 1976). It seems important to gradate the severity of the tetanic form of the disease, which occurs most often and manifests itself very differently - from barely noticeable convulsions to severe tetany. The degree of these disorders largely determines the nature of conservative measures and the features of surgical tactics.

The latent form is characterized by a number of prodormal symptoms (adynamia, lethargy, drowsiness, periodic vomiting, fatigue, loss of appetite, pain in the extremities) observed in patients in this group.

The tetanic form is characterized by general weakness, loss of appetite, frequent profuse vomiting and severe convulsive syndrome.

The fulminant form is very rare. Most patients experience anemia, which increases in parallel with the severity of tetany. Anemia is caused by a decrease in iron absorption due to a sharp deficiency of chlorides in the gastrointestinal tract, impaired hematopoietic function of the bone marrow as exhaustion progresses, and a decrease in the synthesis of the Kestle factor with increasing atrophy of the gastric mucosa. With severe HT, the characteristic clinical symptoms are presented quite clearly, but in its initial stages the convulsive syndrome may be insignificant and not attract the attention of doctors.

Convulsive syndrome is the result of persistent, most often many months (and sometimes many years) vomiting of stagnant gastric contents, which, along with food masses, contain hydrogen, chlorine, and potassium ions. This leads to progressive exhaustion, severe disturbances of EBV (P.S. Fedyshin, 1960; Cain et al., 1954) and CBS (M.A. Chistova, 1965; V.A. Ageychev, 1982). Decompensated metabolic alkalosis, which develops in such situations, is known to lead to significant postoperative mortality, which is especially high in the elderly and senile, even in modern conditions.

Thus, the basis of this complication of ulcer is a sharp shift in the CBS towards alkalosis, which develops due to the loss of a large amount of chlorine and hydrogen ions. This mainly occurs with uncontrollable, painful vomiting, leading to dehydration. As a result of endless vomiting, chlorine is released not only from the blood, but also from the tissues, leading to catastrophic hypochloremia (achloremia). A significant loss of chlorides and electrolytes is accompanied by the breakdown of tissue proteins, resulting in a large number of intermediate products of protein breakdown entering the body.

As a result of the latter, hyperazotemia develops, the amount of bicarbonates in the blood increases to a state of uncompensated alkalosis. Accumulation of phosphates develops, and the amount of calcium in the body decreases. Alkalosis, dehydration, hypocalcemia, hypoproteinemia (hypoalbuminemia), accumulation of nitrogenous waste in the blood lead to overexcitation of the neuromuscular system. The latter is manifested by increased muscle tone, cramps, emotional lability and even meningeal phenomena. These functional changes, in turn, cause profound and sometimes irreversible changes in parenchymal organs.

In severe forms of this complication, vomiting can be debilitating, 3-4 times a day. Patients are very depressed, their consciousness is confused, they hardly answer questions or answer inadequately. The patient is indifferent to his surroundings and sometimes loses consciousness when standing up. Patients are exhausted, dehydrated, sometimes cachectic, lethargic and pale. The skin is sluggish, with a sharp decrease in turgor, lips and fingertips are cyanotic, facial features are sharpened, the tongue of these patients seems to tremble, is covered with a whitish coating, is dry, and tonic convulsions are noted. The condition of the patients is depressed, inhibited, there is a blackout of consciousness, paresthesia of the arms, horizontal nystagmus, the skin is pale icteric in color, its sensitivity is impaired, and tendon reflexes are increased.

There is a convulsive contraction of the hands - “obstetrician’s hand” (Trousseau’s symptom), the eyes are motionless, general convulsions are noted, neck rigidity, teeth in a compressed state (trismus), Chvostek’s symptom, Erb’s, etc. are detected. Delirious adjustments are noted. Prolonged persistent constipation and severe oliguria appear. Blood thickening is observed, the hematocrit is 1:3, the amount of chlorides in the blood decreases (below 400 mg% when the norm is 500 mg%), the same happens in the urine (chlorides are 2.0-3.0 instead of 10-15.0 in normal). Azotemia and oliguria increase.

On physical examination, all patients reveal a sharp enlargement of the stomach, which contains a lot of fluid and occupies most of the abdominal cavity, and asymmetry of the abdomen is noted. On an empty stomach, a characteristic, pronounced splashing noise and increased gastric peristalsis are detected. With severe HT, the characteristic clinical symptoms are presented quite clearly, but in its initial stages the convulsive syndrome may be insignificant and not attract the attention of the doctor. At the same time, timely detection of even the mildest forms of HT has extremely important diagnostic and prognostic significance. The pulse is weak and tense, sometimes thread-like, blood pressure is 80/60 mm Hg. Art. ECG - decreased amplitude, severe myocardial damage. Anemia, hyperleukocytosis, increased ESR, and severe hypoproteinemia are noted. With RI, there is a sharp narrowing and deformation of the pylorus. SO is atrophied, hyperemic, multiple and superficial erosions are noted.

The diagnosis is made on the basis of clinical data, the results of studying the motor-evacuation function of the stomach (RI, balloonography, continuous electro- and radiogastrography, EI).

Treatment GT must begin with conservative measures in the intensive care wards of a surgical hospital and be carried out together with an anesthesiologist-resuscitator. Correction of disorders in the internal environment of the body is carried out through balanced infusion therapy through peripheral and central veins. Elimination of water and electrolyte disturbances is achieved by endoscopic intubation through the area of stenosis with a thin catheter, through which enteral nutrition is provided to patients.

The initial task of treatment measures is to combat alkalosis. For this purpose, electrolyte solutions are administered intravenously, 10 ml of a 10% calcium chloride solution is prescribed for intravenous administration for 5-6 days, a hypertonic sodium chloride solution (5-10% solution - 80-100 ml ), 800-1000 ml of isotonic solution, 5-10% glucose solution with an adequate amount of insulin (1 unit of insulin per 4 g of glucose). B vitamins, ascorbic acid, cocarboxylase, ATP, rheopolyuglucin, hemodez (400-500 ml), fresh (native) or dry plasma (200-300 ml), potassium chloride (0.3% - 1000 ml) are also prescribed ). After the patient's condition improves, surgery is performed.

To resolve issues of surgical tactics for HT, it is necessary to take into account its form, the age of the patient, the severity of his condition, the degree of impairment of EBV, protein metabolism and the nature of concomitant diseases. The more severe the form of HT and the general condition of the patient, the more minimal the surgical intervention should be. Gastric resection is performed, and in cases of very severe patients, GEA is applied. Some authors (I.Yu. Ibadov, Yu.A. Nesterenko, 1984; etc.) combine GEA with SPV.

Grigoryan R.A.

A very rare disease is also identified by Albright (1942) pseudohypoparathyroidism. Changes in the blood correspond to those with insufficiency of epithelial bodies, however, there is no reaction to the administration of parathyroid hormone and AT 10 due to special damage to the renal tubules, so pathogenetically, according to Albright, one should assume insufficient reactivity of the executive organ in relation to the hormone. This interpretation is still disputed by many authors.

Diagnostically pseudohypoparathyroidism can be distinguished from true insufficiency of epithelial cells using the Ellsworth-Howard test: normally, and especially with insufficiency of the parathyroid glands, after intravenous administration of 60 units of parathyroid hormone from Lilly, after 1-3 hours there is a clear increase in the excretion of phosphates in the urine , while in pseudohypoparathyroidism this phosphaturia is absent (Jesserer).

Hypoparathyroid cretinism(Schupbach) is also rare. Keeping this diagnosis in mind, the combination of cretinism with the classic symptoms of hypocalcemia makes it easy to distinguish this form from cretinism itself.

There was a corresponding case also described by Gsell. However, Jesserer does not recognize this special form of tetany, in which various endocrine glands are simultaneously affected, and believes that such changes are possible with any early-onset and especially long-term tetany.
To recognize latent parathyroid insufficiency Various samples have been proposed.

Funfgeld believes that hidden deficiency epithelial bodies can be detected by comparing serum calcium levels before and after twice taking 20 drops of AT10 for 7 days (in people with normocalcemia). If the calcium level remains unchanged or decreases, tetany exists. According to Klotz, tetany is supported by a decrease in serum calcium of at least 10% within 2 hours after subcutaneous administration of 20 mg progynone (induced hypocalcemia).
However, according to research Hadorn, both of these tests are not conclusive for tetany.

With normocalcemic tetany First of all, you should look for factors that can cause alkalosis.
It appears that it has not yet been decided whether alkalosis per se affects on the neuromuscular system in the sense of increasing tetanic excitability (Hadorn) or it has an indirect effect by reducing the amount of ionized calcium.

Of particular importance is hyperventilation tetany. Every doctor has to encounter this form of tetany, often in fearful individuals, especially women. In all situations that are accompanied by increased respiratory activity, i.e., mainly during states of fear (operations, fear neuroses), hyperventilation tetany very easily occurs in sensitive individuals. The diagnosis is made on the basis of a tetanic attack in conditions of hyperventilation, i.e., in the appropriate situation . Chvostek's sign is strongly positive. However, the data from a chemical blood test are, of course, completely unconvincing.
If possible stop hyperventilation, which is usually facilitated by the calming presence of a doctor, tetanic manifestations subside within a few minutes.

Jesser ranks among normocalcemic group also so-called idiopathic tetany. In this case, we are talking about a form of tetany that occurs not as a result of some other disease, but “by itself.” It occurs mainly at a young age, mainly in women.

Come to the fore tetanic seizures, repeated for no apparent reason, varying in intensity and frequency and almost always accompanied by a feeling of fear. However, sensitive and easily excitable individuals are usually affected.
There are gradual transitions to hyperventilation tetany. In some cases, severe attacks of tetany were caused by hyperventilation.

Even when free from seizures periods with completely normal levels of calcium and phosphorus in the blood, Chvostek’s symptom and, less clearly, Trousseau’s symptom are positive and even (often) sharply positive. Pregnancy tetany also refers to normocalcemic tetany; at present it is extremely rare.

Gastric tetany(chloroprivate tetany) is observed after frequent, profuse vomiting with a very large loss of chlorides. Tetanic seizures in pancreatitis are explained by the binding of calcium by necrotic pancreatic adipose tissue.
Muscle cramps Pain in the limbs is also caused by tetanus and strychnine poisoning.

Muscle cramps In addition, they can occur due to overexertion (for example, cramps of the calf muscles when walking, etc.). In internal medicine, muscle cramps associated with the profession are important. One can recall the spasms of stenographers, typists, milkmaids, scribes, musicians, etc. Their cause is unclear. Mental factors probably also play a significant role.

Tetany- a pathological condition that is characterized by convulsions and increased neuromuscular excitability due to a decrease in the concentration of ionized calcium in the blood serum against the background of alkalosis.

Distinguish tetany of newborns (early and late hypocalcemia of newborns), hypocalcemic tetany, rickets tetany, as a result of hypothyroidism (parathyroid rickets tetany), gastric, enterogenic, hyperventilation tetany, etc.

Early hypocalcemia of newborns occurs due to the cessation of calcium supply from the mother to the newborn’s body, functional immaturity of the parathyroid glands, which occurs in premature infants and children with low birth weight, ante- and perinatal stress (toxicosis of pregnancy, hyaline membrane disease, placental rupture, trauma to the c. n.s. of newborns, asphyxia), as well as diabetes mellitus or hyperparathyroidism detected in the mother. The disease is manifested by small tremors of the chin and fingers, rapid breathing with periodic stopping, frequent shallow breaths with retraction of the intercostal spaces, vomiting and convulsions; Sometimes there is laryngospasm.

Late-onset hypocalcemia of newborns It is not clinically manifested until the child’s body receives a load of phosphates for several days (with the introduction of cow’s milk into the diet), resulting in hyperphosphatemia (the kidneys during this period are not able to remove excess phosphorus). Increased deposition of calcium phosphate in bone tissue, the inhibitory effect of calcitonin on bone resorption, a decrease in the effect of parathyroid hormone on bone tissue, and disruption of magnesium homeostasis lead to the development of hypocalcemia.

Manifestations of newborn tetany disappear by the 21st day of life. If hypocalcemia persists for a longer period of time, it is necessary to urgently find out its causes.

The severity of clinical manifestations of tetany with parathyroid insufficiency is very wide - from the absence of any symptoms to persistent hypoparathyroidism syndrome.
The first signs of tetany include muscle pain and spasms, a crawling sensation, numbness in the upper lip, toes and hands, coldness of the extremities, stiffness and stiffness of the joints. At intervals of several days, weeks or months, convulsions develop with loss of consciousness, which occur mainly in the flexor muscles, so the hand takes on the character of an “obstetrician’s hand.”
Facial muscle spasms are accompanied by trismus and a “sardonic smile”, the appearance of a “fish mouth”. Quite often, cramps can begin with abdominal pain, manifested by pylorospasm with nausea and vomiting, spasms of the intestines and bladder. Spasm of the coronary arteries is accompanied by acute pain in the heart with changes on the ECG, which are characteristic of both hypocalcemia and myocardial ischemia.
The child throws his head back, laryngospasm appears (with shortness of breath and cyanosis) until asphyxia develops. This condition is often mistaken for epilepsy. Convulsions may be accompanied by increased intracranial pressure, headache, and swelling of the optic discs.

Enterogenous tetany is the result of impaired calcium absorption in the intestine.

Gastric tetany occurs after frequent profuse vomiting with loss of large amounts of chlorides, with severe early toxicosis of pregnancy, in patients with pyloric stenosis, as well as with congenital chloride diarrhea. Chronic loss of chlorides leads to a reduction in the volume of extracellular fluid and an increase in the concentration of bicarbonates in the plasma, the development of metabolic alkalosis.

Clinical manifestations of enterogenous tetany the same as for insufficiency of the parathyroid glands.

Hyperventilation tetany develops with primary hyperventilation syndrome due to lesions of the central nervous system. (encephalitis, cerebral hemorrhage, trauma), viral infection, obstructive bronchitis, when sudden hyperpnea is possible, lasting several days and leading to respiratory alkalosis. Alkalosis causes a decrease in calcium ionization.
Also, with all types of pathology accompanied by increased respiratory activity, hyperventilation tetany easily occurs during pregnancy, especially when accompanied by anemia.

Mechanical hyperventilation, such as during mechanical ventilation, may cause iatrogenic tetany . This tetany develops with excessive alkali therapy for conditions of acididosis in the post-acidotic phase; during blood transfusions, when the amount of administered citrate is large and calcium is insufficient; in case of intoxication with chloroform, carbon monoxide, morphine, salicylates; abuse of diuretics and laxatives; poisoning with salts of oxalic acid, fluorine; during treatment with aminoglycosides (due to hypomagnesemia), etc.

Tetany is a dangerous condition, especially in children. Therefore, early recognition of latent tetany is very important, for example by identifying Chvostek, Weiss and Trousseau symptoms, as well as hypocalcemia.
Tapping with a finger or a hammer at the outer edge of the orbit along the zygomatic branch of the facial nerve causes contraction of the orbital part of the orbicularis oculi muscle and the frontal muscle (Weiss symptom).
Chvostek's sign is caused by lightly tapping the trunk of the facial nerve in front of the external auditory canal, while contracting either all the muscles innervated by the facial nerve (Chvostek I’s symptom), or the muscles of the area of the corner of the mouth and wings of the nose (Chvostek’s symptom II), or only the muscles of the area of the corner of the mouth ( Chvostek's sign III).
Trousseau's sign manifested by the development of tetanic contracture of the hand (“obstetrician’s hand”) when the shoulder is compressed until the pulse disappears for 2-3 minutes.
Passive flexion at the hip joint of the leg straightened at the knee joint with the patient lying on his back causes convulsive spasm of the hip extensors and supination of the foot (Schlesinger-Poole symptom).
When struck with a neurological hammer on the middle part of the anterior surface of the leg, convulsive plantar flexion of the foot occurs (Petain's symptom).

A decrease in the concentration of total calcium in the blood below 2.12 mmol/l is accompanied by convulsive attacks.
In newborns it is necessary to differentiate with convulsions due to cerebral edema due to asphyxia, bilirubin encephalopathy, hypoxia, intracranial hemorrhage, hypoglycemia, malformations of the brain; Particular tetanic convulsions are observed with tetanus, purulent meningitis, and congenital toxoplasmosis.
In infants, an attack of convulsions often occurs at a high (about 39°) temperature, in most cases on the first day of fever, in the initial period of an infectious disease (acute respiratory viral infection, intestinal infections, urinary tract infections, etc.), as well as in as a result of vaccination.
Laryngospasm is differentiated from laryngotracheobronchitis, acute stenotic, congenital stridor.

TREATMENT

An attack of tetany is inhibited by slow intravenous administration of 10-15 ml of a 10% solution of gluconate or calcium chloride. If necessary, the procedure is repeated up to 2-4 times a day.

5-10 ml of 25% magnesium sulfate solution is injected intramuscularly; Sibazon (Seduxen, Relanium) is prescribed.

For laryngospasm, if there is no rapid effect from the administration of calcium and asphyxia increases, tracheotomy is indicated.

Emergency measures to correct metabolic disorders followed by surgical intervention are necessary for gastric tetany due to decompensated pyloric stenosis.

Conservative therapy aimed at normalizing calcium, acid-base homeostasis and preventing tetanic attacks depends on the disease that is the cause of tetany.

Forecast generally favorable and depends on rational treatment of the underlying disease. During an attack, laryngospasm poses an immediate threat to the patient's life.

Forecast with tetany arising from chronic renal failure, unfavorable.

Seizure prevention tetany is the treatment of the underlying disease, normalization of the level of ionized calcium in the blood, elimination of factors contributing to the manifestation of tetany (hyperventilation, hypothermia, mental trauma, etc.).

Catad_tema Stress - articles

Natekal D3 in the treatment of latent tetany associated with psychovegetative syndrome.

increased breathing,
paresthesia,
tetany.

The presence of tetanic symptoms in the structure of the HVS is considered a highly pathognomonic diagnostic sign (2). Symptoms of neurogenic tetany tend to persist and are difficult to treat with psychotropic drugs. Even after successful treatment of psychovegetative syndrome, many patients retain symptoms of tetany, which makes remission incomplete. Probably, tetanic symptoms of unknown origin for the patient and hypochondriacal fixation on them, forming a “vicious circle,” aggravate anxiety, chronicizing the neurotic disease. Therefore, the treatment of latent tetany is as urgent a task as the actual therapeutic effect on the HVS.

Clinical manifestations latent tetany are presented in Table 1.

Table 1. Clinical and paraclinical manifestations of neurogenic tetany.

We conducted an open “pilot” study of the effectiveness of high doses of vitamin-calcium therapy in the treatment of hyperventilation tetany.

To the study turned on patients meeting the following criteria:

The leading complaint is dyspnea, paresthesia and/or muscle spasms of the limbs
positive Chvostek's sign (grades I-III) and Trousseau-Bonsdorff test
presence of an anxiety disorder meeting the ICD-10 criteria for panic disorder or generalized anxiety disorder
patient age over 20 years
absence of current somatic diseases
absence of comorbidity of anxiety disorder with psychotic disorders
patient consent to participate in the study.

Treatment was prescribed after discontinuation of previous therapy for at least 2 weeks. Natecal D3 was prescribed 1 chewable tablet twice a day. The duration of treatment was 4 weeks.

Rice. 1 Dynamics of “tetanic symptoms”

Rice. 2 Trousseau-Bonsdorff test

Some positive trend (p Fig. 3 Dynamics of the intensity of hyperventilation and the total score of vegetative dystonia.