Gastrogenic tetany. Neurogenic tetany syndrome

Hyperventilation disorders (hyperventilation syndrome [HVS]) are extremely common in the clinical structure of autonomic dysfunction that accompanies various diseases. R.E.Brashear et al. divide the etiological factors of HVS into organic, emotional and associated with a certain habit of breathing. The organic causes of HVS are quite numerous: these are neurological and mental disorders, vegetative disorders, respiratory diseases, some diseases of the cardiovascular system and digestive organs, exogenous and endogenous intoxications and other disorders, taking certain medications. Triggers are stress, pain, infection, reflex effects, etc. These factors contribute to an inadequate increase in pulmonary ventilation and the development of hypocapnia. Interesting data were obtained by Russian researchers, according to which, when chronic course cervicalgia in combination with vertebral artery syndrome in 84% of cases, HVS was detected, confirmed by the results of capnography (Solodkova A.V., 1992). Apparently, a violation of the blood supply to the brain leads to a violation of the regulation of respiration and facilitates the development of hyperventilation in response to stressful situations. In 60% of patients, the leading etiological role in the occurrence of HVS is assigned to psychogenic factors. In a study conducted by the group of A.M. Veyna together with N.G. Shpitalnikova, the majority of patients with HVS had actual psycho-traumatic circumstances, and 55%, in addition, had childhood psychogenies. Peculiarities of children's psychogenies consisted in the fact that their structure, as a rule, featured respiratory dysfunction (observation of attacks bronchial asthma, shortness of breath in loved ones, suffocation of a brother drowning in front of our eyes, etc.) [Vane A.M., Moldovanu I.V., 1988;]. Lum et al. as one of the main etiological factors of HVS, they described the habit of breathing incorrectly, which is formed under the influence of previous life experience, as well as stressful situations experienced by the patient in childhood. Many patients with GVS in the past had an increased load on respiratory system due to sports, playing wind instruments, etc. Even in the absence of a feeling of lack of air, many patients, experiencing any "incomprehensible" sensations, begin to breathe deeper in order to "breathe in more oxygen." When shortness of breath occurs, patients with GVS experience fear, anxiety, which leads to fixation of attention on these sensations and aggravation of hyperventilation.

The importance of diagnosing and treating HVS, first of all, is determined by its direct participation in the pathogenesis and symptom formation of many diseases. clinical manifestations psychovegetative syndrome (PVS). The symptom-forming factor HVS is realized through the mechanisms of hypocapnia and related processes, including those leading to tetany. In classical descriptions of hot water supply, a triad of features has always been distinguished:

[1 ] increased breathing;
[2 ] paresthesia;
[3 ] tetany.

read also the post: Hyperventilation syndrome(to the website)

The presence of tetanic symptoms in the HVS structure is considered pathognomonic. diagnostic sign. Symptoms of neurogenic tetany are prone to persistence and are difficult to treat with psychotropic drugs. Even after successful treatment of PVS, many patients continue to have symptoms of tetany, making remission incomplete. Probably, the tetanic symptoms of unknown origin for the patient and the hypochondriacal fixation on them, forming a "vicious circle", exacerbate anxiety, chronicizing the neurotic disease. Therefore, the treatment of latent tetany is just as important a task as the actual therapeutic effect on the GVS.

Vivid tetanic manifestations within the GVS, such as carpo-pedal spasms, occur infrequently, in approximately 1-5% of cases. But this is only the tip of the iceberg, which far from exhausts all manifestations of tetany within the framework of the GVS. Hidden or latent tetany is the main underwater part of the iceberg. Clinical and paraclinical manifestations of neurogenic tetany are presented below:

[1 ] paresthesia;
[2 ] pain;
[3 ] painful muscle tension;
[4 ] convulsive muscular-tonic phenomena;
[5 ] clinical correlates of neuromuscular excitability (positive symptom of Khvostek, Trousseau-Bonsdorf test);
[6 ] EMG correlates of neuromuscular excitability.

There are many clinical signs of occult tetany but no specific symptoms, so diagnosis is often difficult. Diagnosis should be based on a combination of symptoms. The most common manifestations of latent tetany are paresthesias. Sensory disturbances (numbness, tingling, crawling, buzzing, burning) and pain differ in spontaneity of occurrence and short duration, predominant involvement of the hands, centropetal type of distribution (directed from the periphery to the center). Most often, sensory disturbances are symmetrical. As a rule, paresthesias precede the appearance of muscle spasms. Muscle cramps following paresthesias capture the muscles of the hands (“obstetrician’s hand”) and feet (carpo-pedal spasms), starting in most cases from the upper limbs. But more often, patients complain of painful information of individual muscles, which are provoked by physical activity, thermal effects ( cold water) or occur during voluntary stretching of the limb.

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

Hyperventilatory tetany is considered normocalcemic, although approximately one third of patients present with hypocalcemia. Voluntary hyperventilation can lead to significant changes 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 fund" 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 shifts in biochemical processes caused by chronic GVS may ultimately lead to an increase in the level of neuromuscular excitability. However, neuromuscular excitability is not an obligate symptom of HVS and is absent in 15–20% of patients with chronic HVS. Probably, for the development of changes in neuromuscular excitability, a combination of factors is required - a constitutional predisposition (possibly in the form of calcium metabolism features) and alkalosis proper caused by GVS.

Read more about DHW and tetany in the following sources:

article "Latent tetany associated with psychovegetative syndrome" by O.V. Vorobieva, E.V. Popova, V.A. Kuzmenko; MMA them. THEM. Sechenov, Department of Nervous Diseases FPPOV (journal "Nervous Diseases" No. 1, 2005) [

27.03.2015

The first clinical description of hyperventilation syndrome (HVS) belongs to Da Costa (1842), who summarized his observations of soldiers participating in civil war. He observed respiratory disorders and related various discomfort in the region of the heart, calling them "soldier's heart", "irritated heart". The connection of pathological symptoms with physical activity was emphasized, hence another term - “effort syndrome”. As early as 1930, it was shown that pain in the region of the heart in Da Costa syndrome is associated not only with physical activity, but also with hyperventilation as a result of emotional disturbances. These observations were confirmed during the Second World War. Hyperventilation manifestations were noted both among soldiers and civilians, which indicated importance psychological factors in the genesis of HVS. In the 1980s and 1990s, it was shown that HWS is part of the structure of the psychovegetative syndrome (vegetative dystonia syndrome).

Prerequisites for the emergence of hot water supply. The respiratory system, on the one hand, has a high degree of autonomy, on the other hand, a high degree of learning and a close connection with the emotional state, especially anxiety. These features of the respiratory system underlie the fact that GVS is in most cases of psychogenic origin. An important role in the development of HVS is played by children's psychogenies (children become witnesses of dramatic manifestations of attacks of bronchial asthma, cardiovascular and other diseases associated with impaired respiratory function). Patients themselves in the past often have an increased load on the respiratory system: running, swimming, playing wind instruments, etc.

Pathogenesis. An important role in the pathogenesis of HVS is played by complex biochemical changes, especially in the system of calcium-magnesium homeostasis. Mineral imbalance leads to an imbalance in the system of respiratory enzymes, contributes to the development of hyperventilation. In the study of I.V. Moldovan (1991) showed that with GVS there is an instability of breathing, a change in the ratio between the duration of inhalation and exhalation.

Thus, the pathogenesis of HVS appears to be multilevel and multidimensional. A psychogenic factor (most often anxiety) disrupts normal breathing, resulting in hyperventilation. An increase in pulmonary, alveolar ventilation leads to stable biochemical changes: excessive release of carbon dioxide (CO2) from the body, the development of hypocapnia with a decrease in partial pressure CO2 in alveolar air and oxygen in arterial blood, as well as respiratory alkalosis. These shifts contribute to the formation of pathological symptoms: impaired consciousness, vegetative, muscular-tonic, algic, sensory and other disorders. As a result, there is an increase mental disorders, a pathological circle is formed.

Clinical manifestations. DHW can be permanent and paroxysmal character(hyperventilation crisis). GVS is characterized by the classic triad of symptoms: respiratory disorders, emotional disturbances and muscular-tonic disorders (neurogenic tetany).

Respiratory disorders are represented by the following types:

"Empty breath". The main manifestation is dissatisfaction with the breath, a feeling of lack of air, which leads to deep breaths. Patients constantly lack air. They open the vents, windows and become "air maniacs" or "fighters for fresh air." Respiratory disorders are exacerbated in agoraphobic situations (metro) or sociophobic (exam, public speaking). Breathing in such patients is frequent and/or deep.

Violation of automatism of breathing. Manifestation - patients have a feeling of stopping their breathing, so they continuously monitor the act of breathing and are constantly included in its regulation.

· Labored breathing. This type differs from the first option in that breathing is felt by patients as difficult, performed with great effort. They complain of a "lump" in the throat, the obstruction of air into the lungs, tightness of breath. Objectively marked increased breathing with an irregular rhythm. In the act of breathing, the respiratory muscles are used. The patient's appearance is tense, restless. Examination of the lungs reveals no pathology.

Hyperventilation equivalents - characterize periodically observed sighs, coughing, yawning, sniffling. These manifestations are sufficient to maintain prolonged hypocapnia and alkalosis in the blood.

Emotional disturbances in HVS are mainly of an anxious or phobic nature. The most common is generalized anxiety disorder.

Respiratory disorders reach the most significant degree during a hyperventilation crisis, which develops as one of the variants of a panic attack. The patient has a fear of suffocation and other symptoms characteristic of a panic attack. To make a diagnosis of a panic attack, four of the following 13 symptoms must be observed: palpitations, sweating, chills, shortness of breath, choking, pain and discomfort in the left side of the chest, nausea, dizziness, feeling of derealization, fear of going crazy, fear of death, paresthesia, waves heat and cold. effective method relief of a hyperventilation crisis is breathing into a paper or plastic bag. In this case, the patient breathes his own exhaled air with a high content of carbon dioxide, which leads to a decrease in respiratory alkalosis and the listed symptoms. If it is not possible to stop the hyperventilation crisis, the patient may develop lipothymia and fainting.

A special place in the clinical picture of HVS is occupied by an increase in neuromuscular excitability, manifested by tetany.

Muscular tonic disorders (neurogenic tetany) include:

Sensitive disturbances in the form of paresthesias (numbness, tingling, burning);

Convulsive muscular-tonic phenomena - spasms, tonic convulsions in the hands with the phenomenon of "obstetrician's hand" or carpopedal spasms;

Chvostek's syndrome II-III degree;

a positive Trousseau test.

In addition, to increase neuromuscular excitability, the Khvostek symptom, a positive Trousseau cuff test and its variant, the Trousseau-Bahnsdorff test, are characteristic. Characteristic electromyographic (EMG) signs of latent muscle tetany are essential in the diagnosis of tetany. An increase in neuromuscular excitability is caused by the presence in patients with HVS of a mineral imbalance of calcium, magnesium, chlorides, potassium, due to hypocapnic alkalosis. There is a clear relationship between increased neuromuscular excitability and hyperventilation. Neurogenic tetany most often occurs in the picture of a hyperventilation crisis.

DHW diagnostic criteria

1. The presence of polymorphic complaints: respiratory, emotional and musculo-tonic disorders, as well as additional symptoms.

2. Absence of organic nervous and somatic diseases.

3. The presence of a psychogenic history.

4. Positive hyperventilation test.

5. Disappearance of symptoms of a hyperventilation crisis when breathing into a bag or inhaling a mixture of gases (5% CO2).

6. Presence of symptoms of tetany: Chvostek's symptom, positive Trousseau test, positive EMG test for latent tetany.

7. Change in blood pH towards alkalosis.

Treatment of GVS requires patience from both the doctor and the patient and is aimed at correcting mental and autonomic disorders, teaching proper breathing, and eliminating mineral imbalance.

Non-drug methods:

- psychotherapeutic methods (the essence of the disease is explained to the patient, the origin of the symptoms of the disease, especially somatic, their relationship with the mental state, they are convinced that there is no organic disease, etc.);

- respiratory gymnastics, the purpose of which is the formation of a new psychophysiological pattern of breathing.

Principles:

Diaphragmatic abdominal breathing, during which the “brake” Hering-Breuer reflex is activated, causing a decrease in the activity of the reticular formation of the brain stem and, as a result, muscle and mental relaxation.

· Certain relationships between inhalation and exhalation: inhalation is 2 times shorter than exhalation.

Breathing should be rare.

· Breathing exercises should be carried out against the background of mental relaxation and positive emotions. Initially, breathing exercises continue for several minutes, later - quite a bit. long time. With severe hyperventilation disorders, breathing in a bag is recommended.

1. Autogenic training, respiratory and relaxation training, acupuncture.

2. Biofeedback method.

Medicinal methods

Hyperventilation syndrome refers to psychovegetative syndromes. Its main etiological factors include anxiety, anxiety-depressive and phobic disorders, therefore, the priority in its treatment is psychotropic therapy, namely anxiolytics (non-benzodiazepine - for long-term therapy of permanent hyperventilation disorders; benzodiazepines - for stopping a panic attack). If necessary, antidepressants with pronounced sedative or anxiolytic properties are prescribed, which, from the standpoint of evidence-based medicine, are a priority for the treatment of frequent panic attacks and, accordingly, hyperventilation crises.

As a means of reducing neuromuscular excitability, prescribe drugs that regulate the exchange of calcium and magnesium. The most frequently used medicines containing calcium for 1-2 months.

In some cases, magnesium deficiency leads to increased neuro-reflex excitability, decreased attention, memory, convulsive seizures, sleep disorders, tetany, paresthesia, ataxia. The generally accepted view is that magnesium is an ion with clear neurosedative and neuroprotective properties. The appointment of magnesium preparations in monotherapy and in complex therapy in combination with psychotropic drugs and non-drug methods of treatment leads to a decrease in the clinical manifestations of HVS.

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

Sometimes the syndrome is observed in newborn children and disappears after about 21 days. In pregnant women, during this syndrome, tetany of the uterus may occur, which significantly complicates childbirth.

Etiology

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

Tetanic convulsions can also be caused by such etiological factors:

• stomach disease;
• endocrine pathologies;
• various injuries that caused hemorrhages in the parathyroid glands;
• due to frequent vomiting and loose stools;
• adenomas about thyroid gland;
• nervous strain and stress;
• violation of acid-base balance;
• congenital pathologies of the parathyroid gland.

Often, tetany can 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 fact that the patient develops neurogenic tetany.

In pregnant women, this syndrome can occur if there is a violation of the functioning of the parathyroid gland. Tetany of the uterus can be caused by such reasons:

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

Classification

Clinicians distinguish the following forms of this pathological process:

• neurogenic (manifested as a result of a hyperventilation crisis);
• enterogenic (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, clinical picture may differ. However, one can distinguish general symptoms this process:

• 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;
• clouding in the eyes.

Diagnostics

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

• tapping with a hammer of the nerve endings of the limbs and the facial nerve;
• pass galvanic current through peroneal nerve and elbow joint;
• pull the limbs of the arms or legs with a rubber band. When conducting this method there may be contraction of the hand, numbness of the limb, or pain. 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. testify to availability this disease there will be a cramp in the flexor muscle of the thigh.

Sometimes, an electrocardiogram can help identify the disease. According to its curve, one can determine such a type of syndrome as latent tetany.

Treatment

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

To drug therapy include drugs that contain vitamin D. These drugs include:

• Ergocalciferol;
• Videhol;
• Dihydrotachysterol.

They also prescribe drugs that contain calcium. Such drugs are considered the most effective in the treatment of tetany.

It is forbidden to take foods and supplements that contain phosphorus, as they interfere with the production of calcium.

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 diet of the patient should contain foods that are rich in calcium. However, you should reduce your intake of dairy products. Although they contain calcium, they have a lot of phosphorus.

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

With tetany of the uterus, independent labor is impossible, therefore, 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 under the influence of this syndrome falls vegetative nervous system, which during the illness is in a state of increased excitability, which can lead to complications.

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

Prevention

specific preventive measures against this syndrome. You can reduce the risk of developing such a pathological process if you follow the rules healthy lifestyle life and undergo regular medical examinations.

Forecast

In most cases, the prognosis for patients with tetany is favorable. The main thing is to start the treatment of this disease on time. A threat to the patient may be laryngospasms that occur during attacks. However, the prognosis is unfavorable for those patients who have concomitant diseases of the gastrointestinal tract and organs of the cardiovascular system.

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Diseases with similar symptoms:

The disease, which is characterized by the formation of pulmonary insufficiency, presented in the form of a massive release of transudate from the capillaries into the lung cavity and, as a result, contributing to the infiltration of the alveoli, is called pulmonary edema. talking in simple words, Pulmonary edema is a condition when fluid stagnates in the lungs, seeping through the blood vessels. The disease is characterized as an independent symptom and can be formed on the basis of other serious ailments of the body.

Muscle contractions that occur due to increased excitability of nerve endings are defined as neurogenic tetany syndrome, accompanied by convulsions. May be overt or covert. An indicator of a pronounced appearance is prolonged, painful muscle contractions with loss of sensation (paresthesia). The latent course is characterized by spasms in the upper and lower extremities.

Causes of the disease

The etiology of the development of the disease is dysfunction of four small lobes located on the back of the thyroid gland. They produce parathyroid hormone, which is involved in the regulation of calcium levels in the body. With insufficient Ca metabolism, the work of the nervous and motor system. The impetus for tetany can be a number of factors:

• intoxication with subsequent accumulation of alkaline elements in tissues and blood (alkalosis);
• diseases of the digestive tract;
• decrease in ionized calcium with the introduction of certain types of drugs;
• prolonged vomiting, diarrhea;
• surgical intervention in the area of ​​the parathyroid glands;
• infectious processes in the endocrine system;
• injuries that caused hyperparathyroidism;
• neurogenic character (stress, exhaustion of the central nervous system);
• violation of acid-base metabolism;
• in an infant, the cause of muscle contraction may be insufficient intake of calcium from the mother;
• inflammatory process in the uterus;
• violation of endocrine exchanges;
• infection, tumor in the pelvic organs.

Spasms affect one group of muscles, but they appear symmetrically.

Classification and main symptoms

The type of disease is determined by the nature, location of spasms and the etiology of excitation of the nervous system.

Neurogenic tetany

It is one of the most common types, characterized by tonic contraction, the cause of which was an imbalance of microelements or hyperventilation of the lungs. Neurogenic tetany syndrome is accompanied by the following symptoms:

• painful muscle spasms of the arms and legs;
• violation of sensitivity: numbness, tingling, feeling of "goosebumps";
• by bending the fingers of the hand with interphalangeal gaps, this forms an unnatural angle in the shoulder and elbow joint(“the hand of an obstetrician”);
• the foot and toes are bent inward towards the sole;
• contraction of facial muscles (Chvostek's syndrome).

At the time of a neurogenic attack, there is increased sweating and tachycardia.

Hyperventilation tetany

Occurs through the action of large physical activity to the respiratory system. Also, the emotional perception of any event can serve as a reason. The psychogenic factor plays the main role in the failure of calcium-magnesium self-regulation. The imbalance has a negative impact on respiratory function, the relationship between inhalation and exhalation is disturbed, hyperventilation of the lungs is formed. Excessive release of carbon dioxide contributes to alkalosis in the tissues. The syndrome is manifested by tonic muscle disorder. The main symptoms relate to respiratory dysfunction:

1. The feeling of lack of air leads to frequent and deep breaths. The reason may be a closed space (claustrophobia), fear of public speaking, a tragic message.
2. Violation of the sequence or complete stoppage of the respiratory function.
3. Tightness, air obstruction ("a symptom of fish").
4. Hyperventilatory displacement: yawning, sighing, coughing.
5. Disturbance of consciousness, disorientation, fainting.

Respiratory anomalies are often observed panic attacks.

Hypocalcemic tetany

It is characterized by parathyroid hormone deficiency, the pathological process inhibits the release of phosphorus (P) by the kidneys and increases the content of the chemical element in the blood. The consumption of P by the bone skeleton decreases, calcium is released, which leads to hypocalcemia and destruction of muscle tissue. The main indicators of pathology are:

• changes in the analysis of blood serum, reduced content alkalis and high levels of calcium and phosphates;
• trophic deviations due to damage to peripheral nerve endings;
• muscle spasms;
• cataract formation;
• enamel defects.

There is a tendency to dermatological anomalies: eczema, peeling, psoriasis.

Latent tetany

The latent form of the syndrome is manifested by the main features:

• muscle tension is accompanied by severe pain;
• loss of sensation (paresthesia) preceded by spasm
• tonic convulsions;
• Chvostek's symptom.

Excitability is manifested by spasms and covers upper limbs and mimic muscles.

pasture tetany

It is determined by a violation in the neuromuscular structure. The etiology is not fully understood. This type of disease applies to animals. For a person, the definition is applied in the case when convulsions appear in the hand and phalanges after prolonged milking of cows without a special apparatus (manually) on summer pastures. The prerequisites for tonic contractions are prolonged tension of a certain muscle group, insufficient production of parathyroid hormone by the parathyroid glands.

Tetany of pregnant women

Pathology manifests itself in the first months, if the bearing of the fetus is accompanied by severe toxicosis. Frequent vomiting causes dysfunction of the endocrine system and excitation of the nerves in the muscle structure. Clinical course expressed with the following symptoms:

• convulsions of the upper (rarely lower) limbs;
• facial spasms with partial speech impairment;
• abnormal contraction of the heart muscle;
• constant tone of the intestines and stomach due to incessant vomiting ends with painful cramps;
• violation of bowel movements (diarrhea, constipation).

Attacks can be single or appear several times during the day. In case of illness, termination of pregnancy is recommended.

Tetany of the uterus

Intensive contraction of the uterine muscles, following one after another, without a time interval. Due to the pathology of placental abruption, the action of drugs or surgery without anesthesia. Spasmodic contractions are accompanied by:

• constant pain in the lower region of the peritoneum;
• incessant cutting spasms of the rectum without subsequent defecation;
• finding the uterus in good shape;
• increased heart rate;
• feeling of strong pressure in the sacro-lumbar region.

With uncontrolled contractions, gas exchange and blood circulation in the fetus are disturbed, often the negative process ends with intrauterine hypoxia. With symptoms of the disease, labor activity is suspended.

Parathyroid tetany

Occurs against the background of surgical intervention in the area of ​​the parathyroid gland. The function of producing a regulator of calcium and phosphorus metabolism is impaired. Insufficient levels of parathyroid hormone lead to a critical decrease in ionized Ca in the blood and an increase in phosphate. This type of pathology is rarely diagnosed, it is manifested by signs characteristic of hypoparathyroidism:

• paresthesia;
• Chvostek's symptom;
• muscle spasms localized in the upper limbs;
• painful menstrual cycle;
• peeling skin, thinning of the nail cornea;
• migraine, depression;
• hair loss.

Symptoms are intermittent, after the normalization of the metabolic process, all body functions are restored.

Tetany in children

The disease develops from birth to 2 years. The reason is a violation of calcium-phosphorus metabolism due to thyroid dysfunction, feeding a child with milk with a high content of P, prolonged exposure to the sun. An excess of vitamin D provokes a change in the alkaline balance, the development of alkalosis. To nervous excitation in muscle tissues leads to a lack of magnesium, chlorides in the blood, vitamin deficiency. Tetany is manifested in children:

• tonic spasm of the hands, accompanied by severe pain;
• maximum flexion of the arms at the wrists and in the area of ​​the elbow joint;
• contraction of the muscles of the larynx, characterized by a breath with a whistling sound;
• the appearance of cyanosis, cold sweat, apnea.

Single symptoms in the form of stiff neck, strabismus, and spasm of masticatory muscles are not excluded.

Diagnostics

The examination of the patient is carried out taking into account:

1. Abnormalities in respiratory function.
2. Hyperventilation lung test (positive).
3. Connections between the emotional state and the manifestation of tonic spasms.
4. Absence of diseases of mental and somatic etiology.
5. Genetic inheritance (detection of cases of tetany in close relatives).
6. Influences on the hyperventilation crisis of inhalation based on special gases.
7. Manifestations of the symptom of Chvostek.
8. Trousseau's trials.
9. Studies using electromyography (EMG) of the bioelectrical ability of skeletal muscles.

way laboratory research the alkaline composition is determined in the direction of the risk of alkalosis.

Treatment

Therapy of neurogenic tetany is long-term, requiring an integrated approach. Along with the use medications the patient is advised:

• get rid of bad habits(alcohol, nicotine, strong coffee);
• do breathing exercises;
• seek advice from a psychotherapist;
• practice autogenic training.

Conservative treatment is aimed at relieving muscle spasms and restoring peace of mind. The drugs are prescribed:

1. Sedative antidepressants (Mirtazapine, Amitriptyline, Fluvoxamine).
2. Without activating action ("Sertraline", "Citalopram", "Escitalopram").
3. Anxiolytics ("Diazepam", "Alprazolam", "Clonazepam").
4. Calcium-magnesium metabolism regulators that reduce nervous excitability in muscles - Calcium-D3, vitamin D2 ("Ergocalciferol", "Videhol").

To exclude paresthesia, normalize heart rhythms, and regulate reflex excitability, drugs containing magnesium and vitamin B6 are included in therapy. To stop a convulsive attack, a solution of calcium chloride and "Parathyreocrine" is introduced. For the treatment of tetany, preparations containing phosphorus are not used, the chemical element does not allow calcium to be fully absorbed.

Possible Complications

Insufficiency of parathyroid hormone can lead to a hypocalcemic crisis, which, without medical care lasts several hours. Convulsions cover the vocal cords, bronchi, cause respiratory failure. Pathology is capable of:

• form calcification of the musculature of the skeleton, internal organs, brain;
• cause cataracts;
• reflect on the nail cornea;
• provoke hair loss.

Tetany during pregnancy affects labor activity, blood circulation in the placenta and gas exchange are disturbed, which leads to asphyxia (suffocation) of the fetus. The continuity of the contraction is an indicator for surgical intervention (C-section). The development of the syndrome in children entails psychological disorders, the manifestation of rickets. With laryngospasm, suffocation and a complete cessation of breathing are possible.

Prevention and prognosis

With the normalization of metabolism by the sufficiency of the hormone produced by the parathyroid glands, the body is completely restored. If the pathology is not complicated by renal failure, recovery occurs in most cases. Therefore, the prognosis for patients is usually favorable.