Medical history (history of illness) represents an important component in the diagnosis of tetany. Family history Social history Is there any evidence of psychosocial stress or strain due to your family situation? Current medical history/systemic history (somatic and psychological complaints). Do you have/had any muscle spasms? When did they first occur? How long did they … Tetany: Medical History
Congenital malformations, deformities, and chromosomal abnormalities (Q00-Q99). Pseudohypoparathyroidism (synonym: Martin-Albright syndrome) – genetic disorder with autosomal dominant inheritance; symptoms of hypoparathyroidism (hypothyroidism) without a deficiency of parathyroid hormone (PTH) in the blood: four types are distinguished according to appearance: Type Ia: concomitant Albright osteodystrophy: brachymetacarpy (shortening of single or multiple metacarpal bones) and tarsy (shortening … Tetany: Or something else? Differential Diagnosis
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body weight, height; further: Inspection (viewing). Skin and mucous membranes Auscultation (listening) of the heart Auscultation of the lungs [due todifferential diagnosis: bronchial asthma]. Palpation (palpation) of the abdomen (abdomen) (pressure pain?, knocking pain?, coughing … Tetany: Examination
1st order laboratory parameters – obligatory laboratory tests. Small blood count Electrolytes – calcium* , magnesium, sodium, potassium. Parathyroid hormone Vitamin D Renal parameters – urea, creatinine, cystatin C or creatinine clearance if necessary. Urine status (rapid test for: pH, leukocytes, nitrite, protein, blood), if necessary sediment, if necessary urine culture (pathogen detection and resistogram, … Tetany: Test and Diagnosis
Therapeutic target Freedom from symptoms Therapy recommendations Causal therapy depends on the etiology of the tetany. In hypocalcemia (calcium deficiency), calcium is injected (20-30 ml calcium gluconate 10%, very slowly i.v., until the Trousseau phenomenon/paw position of the hand as a sign of hyperexcitability in tetany disappears). See also under “Further therapy“.
Obligatory medical device diagnostics. Electrocardiogram (ECG; recording of the electrical activity of the heart muscle)* – for cardiac rhythm monitoring. * Hypocalcemia (calcium deficiency) shows a prolongation of the QT time (time that elapses from the Q wave in the ECG to the end of the T wave) in the ECG. Optional medical device diagnostics … Tetany: Diagnostic Tests
To prevent tetany, attention must be paid to reducing risk factors. Behavioral risk factors Diet Micronutrient deficiency (vital substances) – see Prevention with micronutrients. Disease-related risk factors Endocrine, nutritional and metabolic diseases (E00-E90). Calcium malnutrition Magnesium deficiency or magnesium depletion. Malnutrition Medication For drug poisoning – epinephrine, guanidine, caffeine, morphine. Environmental pollution – intoxications (poisonings). … Tetany: Prevention
The following symptoms and complaints may indicate tetany: Leading symptoms of latent tetany. Reduction in performance Muscle cramps Sensory disturbances Unspecified rheumatoid (rheumatoid-like), migraine (migraine-like), stenocardial (chest– or heart-like), or asthmoid (asthma-like) symptoms, respectively. Leading symptoms of manifest tetany (tetanic seizure). Preceding usually undefined prodromal symptoms (eg, paresthesias). Symmetrical painful tonic muscle spasm with carpopedal … Tetany: Symptoms, Complaints, Signs
Pathogenesis (development of disease) Hypocalcemic tetany (tetany associated with decreased calcium blood levels). Enterogenic/primary calcium deficiency tetany – associated with calcium malabsorption or malnutrition. Parathreogenic tetany – after parathyroidectomy (parathyroidectomy), in idiopathic hypoparathyroidism (parathyroid hypofunction). Pseudohypoparathyroidism (synonym: Martin-Albright syndrome) – genetic disorder with autosomal dominant inheritance; symptoms of hypoparathyroidism (parathyroid hypofunction) without a deficiency of … Tetany: Causes
Therapy for tetany depends on the cause. General measures Calm patients Position upper body upright Suction. Perform bag rebreathing; this should cause exhaled carbon dioxide to be re-inhaled: Co2 ↑ (this, in addition to measures of sedation, is sufficient in hyperventilation tetany with normal serum calcium). Observance of the general hygiene measures! Review of permanent … Tetany: Therapy
