Tetany - syndrome occurring in the form of seizures, and accompanied by severe disorders of Central and peripheral nervous system.
The etiology and pathogenesis. Tetany may occur when the treatment of gastrointestinal diseases (stenoses privratnika, pancreatitis, colitis, dysentery); acute infectious diseases (for example, tetanus) and intoxications; in some endocrine disorders (hypoparathyroidism, Addison's disease, and others); from sharp hyperventilation (for example, in hysteria or encephalitis); after heavy operations; in women during pregnancy and lactation; in children suffering from rickets, and so on, there are cases of idiopathic tetanii.
The basis of pathogenesis tetanii increase neuromuscular excitability arising out of violations of the acid-base balance and lowering of blood ionized calcium. At gastroenteric diseases, these disorders are associated with the loss of a large number of chloride and hydrogen ions (due to fluid loss with vomiting and diarrhea), which causes enhanced by linking C02, and increased protein breakdown, resulting in the accumulation of nitrogenous waste products and excess supply in the blood phosphorus, increased content which promotes the excretion of ionized calcium. Tetany when hyperventilation occurs on the background of alkalosis and hypocapnia, leading to the fall of the content of ionized calcium. Tetany pregnant occurs because of increased calcium intake fruit; in endocrine disorders - resulting in violations of salt metabolism and the acid-base balance, Parathyroid tetany often occurs when the thyroid surgery with complete or partial removal of the parathyroid glands, as well as due to various injuries and chronic infections (tuberculosis, syphilis) as a result of lowering the content of parathyroid hormone. The lack of parathyroid hormone leads to hypocalcemia in two ways: primary due to difficulties mobilization of calcium from the depot and the second time due to the accumulation in the blood of inorganic phosphorus.
The clinical picture. Tetany proceeds by type of hidden and expressed convulsive seizures. The latent (latent) form tetanii is only in the form paresthesia, spasms and cold extremities; sometimes it is not detected for a long time, or under the influence of any precipitating factors (anesthesia, infection, pregnancy, etc) occur more or less explicit seizures.
Expressed tetanicescie seizures occur spontaneously and are tonic muscle spasms, breathtaking mainly flexor muscles of the limbs and muscles of the face, trunk, spine, less frequently, throat and stomach. Cramps more symmetrically capture both upper limbs, although sometimes occur only on one side. Hand usually takes the so-called hand position obstetrician, sometimes compressed in a fist with outstretched thumb. Much more rarely convulsions capture and legs, while the foot is usually stretched, the foot is bent inward, cramps adduktoren legs tightly pressed one to another. Spasms of the muscles of the face are accompanied by trism, lips accept the typical proboscis-like shape. Sometimes due to spasms of the muscles language hampered it. Spasms of the neck muscles and back muscles are accompanied by arching the spine. Involvement in a spasm of the bronchial condition and intercostals muscles and diaphragm can cause respiratory distress. Convulsions heart muscle leading to stenokardicheskie the attack, which can result in death from cardiac arrest in systole. Spasms of the muscles of the stomach and intestines cause vomiting, diarrhea and constipation, cramps urinary bladder difficult urination. As a result of violations of convergence or temporary strabismus comes the vision Cramps muscle sharp pain. The duration of their extremely diverse: from several minutes to several hours. Seizures and convulsions sometimes rare, sometimes repeated at short intervals of time. After the end of attacks you experience weakness or even paralysis.
Autonomic nervous system tetanii overexcited. Often seeing the emergence of a "dead fingers and sharp blanching limbs in causing symptom trusso (typical tonic spasms in his hand when pressing on a nerve in the field sulcus bicipitalis). Patients are highly sensitive to the introduction of vegetotropic substances. For example, the introduction of adrenaline helps to restore the silent convulsive seizure, introduction pilocarpine in the acute stage tetanii causes a sharp flow and salivation, slezotechenie, redness, disorders of cardiac activity, the emergence of vomiting, diarrhea, a significant increase in urination.
Cardiac activity during seizure tetanii reflected in surging tones, sometimes noises appear. A very frequent phenomenon tetanii - pallor due to spasm of peripheral vessels, and angiospastic swelling.
Violations of thermoregulation tetanii expressed as to increase the excitability if the external temperature, and the fluctuations of body temperature at the time of seizures. There are nutritional disorder: hair becomes thin, drop out, are cut; brittle nails, streaked; teeth break, crumble, see the enamel defects. Often in young patients develop cataracts.
During attacks tetanii appears leukocytosis, in the blood is reduced or completely absent fraction of calcium associated with protein, if the saved amount of total calcium, the amount of potassium and phosphorus increased. Tetanii noted alkalosis, in blood and urine is increased nitrogen content.

  • Prognosis and treatment tetanii