Hidden form of spasmophilia in children. Spasmophilia: etiology and causes

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

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

Etiology

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

hypervitaminosis of vitamin D. This is usually observed during the treatment of rickets;
inferior and not balanced diet. Nutrition plays extremely important role V normal development child, and especially in the first months of his life. It was found that spasmophilia progresses more often in children who are on artificial feeding;
prematurity. The risk of developing the disease increases several times in premature babies.

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

Forms

Spasmophilia in children occurs in 2 clinical forms:

latent;
explicit.

Latent form

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

Explicit form

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

. Glottis spasm occurs acutely. The lumen of the larynx may become partially narrowed or completely blocked. As a result, the following symptoms appear: change in voice, breathing problems. The attack does not last long (about 2 minutes). As a rule, after this the child calmly falls asleep;
spasm of the feet and hands. Clinicians also call this state carpopedal spasm. Characteristic symptoms: arms are pressed tightly to the body, hands are in hypertonicity and bent, lower limbs are also in bent position. The duration of the spasm is from a couple of minutes to several hours. Emergency care is required to prevent the development of dangerous complications;
eclampsia. The most severe variant of tetany. First, the following symptoms appear: rare breathing, the child becomes numb. As the disease progresses, along with these symptoms, cramps of the whole body, involuntary biting of the tongue and urination are observed. Typically, such an attack lasts less than half an hour, but there have been cases where it lasted several hours. It is important to immediately begin providing emergency care to your child.

Symptoms

A patient with spasmophilia exhibits the following symptoms:

twitching of muscle structures is observed on the arms and legs;
spasms of the feet and hands;
convulsions may occur throughout the body. This process is usually accompanied by biting the tongue, involuntary urination, impaired consciousness;
laryngospasm;

Since the main reason for the progression of the disease is vitamin D deficiency, which is observed with rickets, these symptoms can be supplemented by signs of this disease.

Illness in adults

Spasmophilia in adults is much less common than in children. The underlying reason for the progression of this condition in adults is unknown. Representatives of the fair sex get sick more often. Risk factors:

severe nervous tension;
the presence of diseases of an infectious nature;
bearing a child and lactation period;
hemorrhages;
the presence of benign and malignant neoplasms in the body;
extraction of the parathyroid glands.

Diagnostics

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

collecting medical history;
inspection. Gives the doctor the opportunity to identify characteristic features rickets;
to assess calcium concentration;

Treatment

If symptoms indicating laryngospasm appear, it is necessary to immediately begin providing emergency care to the child:

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

If an attack begins, you need to call immediately ambulance. To relieve it, specialists inject calcium gluconate or a 10% calcium chloride solution into a vein. All this is carried out under constant monitoring of heart rate. If first aid does not bring the desired results, tracheal intubation is performed to ensure normalization of respiratory function.

The most severe complication spasmophilia - cardiac arrest. In this case, you should start carrying out as soon as possible indirect massage hearts. After the attack is stopped, the child is prescribed to take vitamin D in medium doses for a month as treatment.

Complications

Without adequate and timely treatment, a child may experience:

convulsions;
respiratory dysfunction.

At early detection pathology and restoration of calcium concentration, the prognosis is positive. The advanced form of the disease represents serious danger for life and requires immediate emergency care.

Prevention

It is much easier to prevent pathology than to treat it. If you stick to the following recommendations, then you can significantly reduce the risk of progression of spasmophilia:

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

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Spasmophilia (second name – tetanic syndrome) – painful condition, characterized by increased neuromuscular excitability, in which spasms of certain muscle groups appear, in particular the muscles of the limbs and larynx. From a biochemical point of view, this condition is caused by a decrease in the concentration in the blood ionized calcium. This disease manifests itself to a greater extent in children, but sometimes occurs in adults.

Spasmophilia in children is a painful condition in which a child in the first years of life (6–18 months) is prone to spastic states and convulsions. It is usually pathogenetically associated with rickets and more often affects boys. This is a seasonal disease, so quite often it appears in early spring, during a period of increased insolation.

There are two types of spasmophilia - latent (hidden) and obvious. Until recently, spasmophilia was a very common disease in children, but nowadays it is quite rare. This is explained by a decrease in the incidence of rickets among children.

Among the main symptoms of spasmophilia are an acutely developing attack of convulsions with laryngospasm, loss of consciousness, and respiratory arrest. With such symptoms, it is necessary to urgently seek medical help so that the child can undergo immediate resuscitation measures. Provide emergency assistance in this case, a doctor of any specialization should be ready. Unfortunately, when severe forms of this disease and failure to provide due medical care V in rare cases maybe death. If the attack of tetany continues long time, then the consequences may be a delay mental development child and damage to the central nervous system.

Causes

Spasmophilia develops against the background of acute hypocalcemia combined with electrolyte imbalance and alkalosis, arising due to a rapid and sudden increase in the amount of the active metabolite of vitamin D in the blood. This condition can occur due to simultaneous administration too high a dose of vitamin D2 or D3, i.e. if shock therapy was used.

Also, the reasons for this situation may be the exposure of large areas of bare skin to the spring sun, saturated ultraviolet rays. In addition, the development of hypocalcemia may be due to dysfunction of the parathyroid glands, increased excretion of calcium in the urine, or a decrease in its absorption in the intestine. The cause of the development of the disease may be a decrease in sodium, magnesium, chlorides, and B vitamins in the blood.

Symptoms

Most obvious symptoms diseases are laryngospasms, carpopedal spasms and eclampsia, a combination of these manifestations with each other is possible. With laryngospasm, an acute, rapidly occurring narrowing of the glottis occurs. In this skin the person turns pale, inhalations become hoarse with difficulty sounding, and exhalations become noisy. If the glottis closes completely, the child turns blue, breaks out in a cold sweat, tries to take in air, gets scared, and may lose consciousness. A noisy inhalation occurs after a few seconds, after a while breathing returns to normal. If there is no adequate treatment for spasmophilia, then attacks of laryngospasm may become more frequent, in extreme cases Prolonged respiratory arrest and death may occur.

Another symptom of spasmophilia is carpopedal spasm, in which tonic contractions of the muscles of the feet and hands occur. It begins suddenly, sometimes when changing the child's clothes, can last several seconds and also suddenly stops. After such an attack, swelling of the feet and hands may occur.

Also bright severe symptoms spasmophilia are spasms of mastication and eye muscles with the development of strabismus. A spasm of the respiratory muscles, in which the breathing rhythm is disrupted, and a spasm of the heart muscles, in which there is a risk of cardiac arrest, are extremely dangerous.

Some types of this disease, in particular eclampsia, can manifest as an attack of clonic-tonic convulsions that affect the entire voluntary and involuntary muscle group. This may result in loss of consciousness, spontaneous defecation and urination, foaming on the lips.

Diagnostics

The diagnosis is made by determining the clinical picture of the disease, identifying excessive neuromuscular excitability, and suddenly occurring periodic spastic states of certain muscle groups (facial, respiratory, laryngeal, skeletal). Confirmation of the diagnosis is the identification of hypocalcemia in the patient, combined with hyperphosphatemia, alkalosis and an imbalance of electrolytes in the blood. Additionally carry out laboratory research, blood test with determination of biochemical parameters, EEG.

Treatment

If the patient has sudden attack with clonic-tonic convulsions, loss of consciousness, laryngospasm and respiratory arrest, then immediate emergency resuscitation measures are required:

perform artificial respiration “mouth to mouth” or “mouth to nose”;
begin the fight against hypoxia by using mask inhalation of 100% oxygen;
introduce anticonvulsants, in particular 0.5% solution of Seduxen intravenously or intramuscularly, sometimes into the tongue. This is the most effective drug, children under 3 months. it is used in a dosage of 0.3–0.5 ml, for children under 1 year old – 0.5–1.0 ml, for children under 5 years old – 1.0–1.5 ml, under 10 years old – 1.5–2 .0 ml. The drug has instant action, but short, only about 30 minutes. This short period of time allows doctors to conduct basic research and identify the origin of the seizures.

Effective means of treating spasmophilia in children are enemas from a 2% solution of warm (up to 38°C) chloral hydrate (20 ml). Intramuscular administration of 25% magnesium sulfate in solution (0.2 ml/kg with 2 ml of 0.5% novocaine solution) helps.

Prevention

All measures primary prevention diseases are aimed at preventing its development, as well as early diagnosis and effective, timely treatment of rickets.

Secondary prevention activities are carried out in order to identify the latent form of the disease and carry out adequate therapy. Additionally, post-attack follow-up is carried out for six months to a year. anticonvulsant treatment, which consists of barbiturate therapy. It is necessary to check periodically biochemical parameters blood and take calcium supplements from time to time.

With spasmophilia, the prognosis in most cases is favorable if adequate treatment is carried out and the reasons that caused its development are carried out. In severe forms of the disease, it is extremely important to properly organize secondary prevention, this will help control its flow.

Attention!

This article is published exclusively in educational purposes and does not constitute scientific material or professional medical advice.

Spasmophilia (Greek spasmos - spasm, cramp and philia - predisposition, inclination; rachitic tetany) - a disease of predominantly young children, 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, respiratory arrest is noted at the height of inspiration; in healthy child such irritation causes increased and deepening of respiratory movements; this phenomenon is clearly visible on the pneumogram); peroneus phenomenon (rapid abduction of the foot upon impact below the head of the small tibia in the area of p. 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, the content should be limited as much as possible. cow's milk in the diet (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 fast intravenous administration 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 must be continued until the symptoms of latent spasmophilia completely disappear. 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.

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 disorders of the 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;
replacement breastfeeding 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 there is frequent 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:

muscle spasms 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 of magnesium and calcium solutions;
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;
ensuring direct inflow 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 a timely diagnosis, it is provided 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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Spasmophilia– a disease that is characterized tendency to tonic and tonic-clonic seizures due to impaired mineral metabolism and CBS, leading to increased mechanical and galvanic neuromuscular excitability.

Predisposing factors

Spasmophilia mainly affects children early age from 3 months to 2 years with symptoms of severe rickets. Children over 3 years old get sick relatively rarely. The frequency at an early age is 3-4%. Spasmophilia affects young children who are bottle-fed with unadapted formulas and have symptoms of rickets. More often it develops in spring.

Causes. Pathogenesis.

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

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

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

An attack of spasmophilia can be provoked by any disease with high temperature, frequent vomiting for gastrointestinal diseases, as well as severe crying, agitation, fear, etc.

Diagnostic criteria

Reference features

With hidden form:

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

symptom Trousseau- convulsive contraction of the hand in the form of an “obstetrician’s hand” when the neurovascular bundle in the shoulder area is compressed;

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

Maslov phenomenon- cessation of breathing at the height of inspiration with a slight prick of the skin (in a healthy child - increased and deepening of breathing);

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

In explicit form:

laryngospasm- mild or complete spasm of the glottis. Cyanosis, bulging eyes, the child becomes covered in sticky sweat. Then a noisy inhalation - “rooster crow”. Duration - from a few seconds to 1-2 minutes. The attacks may recur;

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

eclampsia- general attack of tonic-clonic seizures with loss of consciousness. Duration - from a few seconds to 20-30 minutes. Frequently recurring attacks can give a picture of Statusclampticus.
All symptoms of latent and obvious spasmophilia are observed against the background of symptoms of rickets.

Optional signs:

increased nervous excitability ( hyperreflexia, paresthesia);

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

respiratory, less often metabolic alkalosis;

on ECG increasing intervalQ-T > 0.2 With.

Laboratory and instrumental research methods

Basic methods:

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

definition of CBS.

Additional methods:

determination of the level of inorganic phosphorus in blood serum;

Sulkovich's test.

Clinical course options depend on the form of spasmophilia. The latent form precedes the obvious one and can last from several weeks to several months. Usually hidden spasmophilia becomes obvious under the influence of provoking moments (various intercurrent diseases). The most severe manifestation of the obvious form is eclampsia (general attack of tonic-clonic seizures with loss of consciousness). In mild cases, the attack may be limited to pallor, numbness, twitching of various muscle groups, most often the face. After the attack, the children fall asleep.

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

Criteria for the severity of the condition: the presence of convulsive syndromes, especially laryngospasm, bronchospasm.

Complications: the most dangerous is acute respiratory failure.

Duration of the disease: with timely pathogenetic symptomatic treatment duration acute period diseases ( convulsive syndrome, fearfulness, anxiety, disturbing dream, laryngo-, bronchospasm (maximum 20-30 minutes).

Forecast. At timely diagnosis and adequate treatment is favorable.

Urgent Care

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

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

If seizures are combined with high body temperature, intramuscular administration of a 2.5% solution of chlorpromazine at the rate of 1 mg per 1 kg of body weight is indicated. In case of frequently recurring attacks of clonic-tonic convulsions, when a large fontanelle bulges, it is necessary to do spinal tap with the removal of 8-10 ml of liquid.

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

Treatment.

Pre-hospital stage:

limit milk in your diet;

transfer the baby to breastfeeding breast milk or adapted mixtures;

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

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

3-4 days after prescribing calcium supplements vitaminD2 per therapeutic dose;

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

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

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

Criteria for correct treatment:

improvement clinical manifestations illness, disappearance of symptoms of latent and obvious forms of spasmophilia;

Normalization of laboratory parameters.

Indications for consultation with specialists

In case of increased excitability, convulsive readiness, consult a neurologist; for laryngospasm - an otolaryngologist.

Indications for hospitalization: obvious spasmophilia; Difficulties in diagnosis.

Hospital stage:

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

other therapeutic measures- see Pre-hospital treatment.

Rehabilitation after discharge from hospital- see Rickets.

Prevention

Prevention of rickets (see);

maintaining natural feeding;

calcium supplements, especially during breastfeeding;

excitable children - bromine preparations

Outcomes.

The prognosis in most cases is favorable; very rarely, a severe attack of laryngospasm can be fatal. A very prolonged eclamptic state can have a negative impact on the central nervous system - further delay in mental development is possible.