In tetany, there is a hyperexcitability of the muscles and nerves. This can manifest itself in cramp-like disturbances of the motor function up to the very painful muscle spasm, but in milder cases it can also show only by a tingling sensation. Most often, tetany affects either the face, and in this case the facial nerve, or the arms and legs.
What is tetany?
Tetany is the hyperexcitability of nerves and muscles, which can manifest from mild tingling to disturbances in motor function to very painful muscle spasms. Most often, tetany affects the arms, legs or face. Both hypocalcemic tetany and normocalcemic tetany are possible causes. In both cases, but for different reasons, the serum calcium level in the blood drops. The symptom is then a tetanic seizure, usually in the face, arms, or legs, but in rare cases also in the urinary bladder, intestines, or respiratory muscles. When diagnosing tetany, it is important to find the exact cause, because only then can tetany, which is only a symptom, be properly treated.
Causes
There are several causes that cause tetany. One of the causes is hypocalcemic tetany. In this case, the serum calcium level is decreased. Reasons for this can be vitamin D deficiency, kidney weakness, pancreatitis, but also food intolerance to gluten or calcium absorption disorder. Therefore, the electrical conductivity of the nerve-muscle transmission changes, resulting in increased excitability of the muscle cells. Another cause is normocalcemic tetany. In this case, too much calcium is bound, so therefore the free serum calcium decreases. Reasons for this form of tetany can be magnesium deficiency, but also hyperventilation or head trauma, as well as severe vomiting.
Symptoms, complaints, and signs
The tetanic seizure can be considered a symptom of tetany. This seizure often begins with tingling of the corresponding body region. Mental symptoms such as irritability, restlessness, or even anxiety may also be present. In most cases, the typical muscle spasms then occur in the face, arms or legs. In the face, the so-called fish mouth position can occur. If the arms are affected, the hands are often cramped to the paw position. If the muscle spasm occurs in the legs, the pointed foot position is a typical sign of tetany. Rather rarely, the urinary bladder, intestines or respiratory muscles may also be affected. Urinary urgency, diarrhea and shortness of breath are then usually the result. Most tetanic seizures last only minutes. However, it can happen that such seizures can sometimes last up to several hours. In such cases, a calcium injection from a doctor usually helps.
Diagnosis and course of the disease
Tetany in itself is only a symptom. The diagnosis then depends on finding out the exact cause. Often, a blood test already helps. Here, the concentration of electrolytes as well as calcium per se, but also vitamin D and parathormone are determined. It may also make sense to determine the kidney values in order to find kidney diseases. It may be necessary to investigate whether there is inflammation of the pancreas or an underactive parathyroid gland. It may also make sense to evaluate the patient to see if gluten intolerance is present. Whether the tetany was caused by hyperventilation can be determined by examining the blood gases.
Complications
If tetany is left untreated, serious complications can occur. As a result of the disease, the kidney is initially damaged. In the worst case, failure of the organ or dysfunction may occur. The latter is associated with discomfort urinary tract infections, pain and sepsis. Other organs are also damaged in the course of a tetanic seizure – for example, there are complaints of liver, gall bladder and brain. In the case of the brain, the condition can cause permanent damage, resulting in neurological and mental deficits. In the further course, tetany can cause paralysis, usually associated with psychological complaints such as anxiety disorders or depression. In the last consequence, the overexcitability of the muscles finally leads to unconsciousness and death of the patient.In less severe cases, complications such as urinary urgency and incontinence occur, as well as breathing difficulties. Accompanying dehydration and deficiency symptoms can occur, which if left untreated can also lead to neurological deficits and other complaints. In the treatment of tetany, the risks come mainly from the incorrect use of medications. For example, drainage and laxative medications can exacerbate the symptoms.
When should you see a doctor?
In the event of a tetanic seizure, an emergency physician should be called. Initial signs such as the typical tingling, restlessness, or irritability should be observed and treated if possible. The patient should lie down quietly and wait until the seizure has subsided. A mild seizure lasts only a few minutes. Meanwhile, the affected person must be observed and calmed down. Sometimes symptoms such as shortness of breath or diarrhea occur, which require immediate treatment. If breathing is difficult, the affected person should unbutton his or her top and lie down in a supine position. Severe attacks can last several hours and should be treated by a doctor. The physician can relieve the symptoms quickly by means of a calcium injection. Therefore, in the case of tetany, it is always best to call a doctor or the person should be taken to a hospital. In the case of repeated seizures, a doctor must determine the cause. Possibly there is a kidney disease or an inflammation of the pancreas, which must be treated first. Depending on the cause, the nephrologist, internist and orthopedist may be responsible in addition to the family doctor.
Treatment and therapy
Generally, in the case of tetany, it is important to find out the underlying condition and treat it accordingly. If the tetanic seizure is caused by hyperventilation, it is helpful to have the patient breathe into a plastic bag, as this allows too much exhaled carbon dioxide to return to the bloodstream. In cases of bad tetanic seizures, which can last for hours at times, a calcium injection is helpful. It is further important to note that calcium overdose should also not occur during treatment. If calcium or magnesium deficiencies are due to an improper diet, nutritional counseling will help. The incorrect use of medications such as drainage or laxatives can also lead to disturbances in electrolyte levels and thus to tetany. Here, too, a thorough explanation by the treating physician is necessary.
Prevention
In cases where tetany is not caused by a serious underlying disease, which must then be treated in any case, tetanic seizures caused by disturbances in electrolyte balance can often be prevented by an overall healthy lifestyle and diet. Vitamin D is primarily formed by spending sufficient time outdoors in daylight. Especially in the dark season, it is therefore important to use the hours when there is enough daylight for walks or sports in the great outdoors. The diet should contain enough calcium as well as magnesium. People who eat a whole-food diet will not normally become calcium or magnesium deficient in their diet. Too much alcohol has a dehydrating effect and can also draw too many electrolytes from the body. The same is true for dehydrating drugs and laxatives. Therefore, it is important to be careful with too much alcohol as well as when using said medications.
Aftercare
Tetany is a cramping of the muscles. Since these muscle cramps can be due to various causes, the aftercare is also related to the causative disease accordingly. Basically, tetany can be caused by a deficiency of magnesium, but these deficiency symptoms can be caused by other diseases, for example of the thyroid gland. Thus, the aftercare of the tetany itself is not necessary, but the mostly permanently required treatment of the actual disease. A special form of tetany is psychogenic tetany, which occurs in psychiatry and can cause epilepsy-like seizures. Thus, follow-up care is always designed to address the underlying disease and, for the most part, not the tetany itself. Acute treatment of tetany completes the necessary measures. It must be determined by a specialist whether long-term therapy with certain medications is required for the respective patient, which can prevent or suppress the recurrence of tetany or at least attenuate it.Individual consultation with a specialist is essential in this case. The patient should be educated and informed about how to prevent tetany. If there is an underlying systemic disease on which the tetany is based, lifelong treatment may be required, so that one cannot speak here of mere aftercare.
Here’s what you can do yourself
In the case of tetany, the first thing to do is to compensate for the causative calcium deficiency. This can be achieved by changing the diet or by taking dietary supplements. In addition, the patient must take it easy, as the muscle cramp is usually extremely painful. If the cramp is particularly intense, medication may also have to be taken. The patient should contact the doctor and note down the complaints in a diary. Particularly in the case of persistent complaints, as can occur in normocalcemic tetany, treatment of the pain must take place at the same time. The causative alcolosis must be treated by bed rest and avoidance of risk factors. The tetany should subside after a few hours. If the symptoms persist for longer, there may be a serious underlying disease. The patient should consult a specialist, who will arrange for further blood count testing if necessary. In severe seizures, epilepsy-like disorders may occur. In this case, first responders must restrain the affected person so that he or she does not injure him or herself. The affected person must be calmed and, if available, treated with an emergency medication. Subsequently, an examination in the hospital is necessary.
