The hand of the obstetrician causes. Spasmophilia

Obstetrical rotation, an operation, with the help of a swarm, you can change the given position of the fetus, for some reason unfavorable for the course of childbirth, to another, more advantageous, moreover, of course, always only to a longitudinal position. (History of A. p., see Obstetric ... ...

RUDOLPHI- Karl (Rudolphi Karl Asmund, 1771-1832), founder of helminthology; He graduated from the Faculty of Philosophy and Medicine in Greifswald, and held the Department of Anatomy and Physiology in Berlin for 22 years. Helminthology became interested in student ... ... Big Medical Encyclopedia

Spasmophilia- SPASMOPHILIA - a disease of young children, characterized by a tendency to tonic and clonic tonic convulsions due to hypocalcemia. Etiology and pathogenesis. The content of calcium in the blood serum with rickets decreases in ... ... Wikipedia

Tetany- I Tetany (tetania; Greek tetanos tension, spasm) is a pathological condition characterized by a convulsive syndrome and increased neuromuscular excitability due to a decrease in the concentration of ionized calcium in the blood serum, as ... ... Medical Encyclopedia

Smellie-Siegemundin reception- (W. Smellie, 1697 1763, English obstetrician; J. Siegemundin, 1648 1705, German midwife; syn. double manual reception) obstetric rotation of the fetus on the leg, in which one hand of the obstetrician inserted into the uterus pushes the head up, and the other pulls the leg for ... ... Big Medical Dictionary

Smelly - Siegemundin reception- (W. Smellie, 1697 1763, English obstetrician; J. Siegemundin, 1648 1705, German midwife; syn. double manual reception) obstetric rotation of the fetus on the leg, in which one hand of the obstetrician, inserted into the uterus, pushes the head up, and the other pulling... ... Medical Encyclopedia

Spasmophilia- I Spasmophilia (spasmophilia; Greek spasmos spasm, spasm + philia tendency; synonym: rachitogenic tetany, spasmophilic diathesis) is a pathological condition that occurs in children with rickets in the first 6-18 months. life; characterized by... Medical Encyclopedia

Hypocalcemic crisis- Thetan attack ... Wikipedia

maine d "obstetrician- * main d accoucheur. honey. hand deformity. Obstetrician's hand. BME 1934 411 ... Historical Dictionary of Gallicisms of the Russian Language

Rigid Man Syndrome- Syn.: Syndrome of "stiff person". Mersh-Woltman syndrome. Progressive symmetrical muscle rigidity, usually manifesting in men aged 20-40 years. Muscle tension and painful muscle spasms build up over several ... ...

The Bullet Phenomenon- spasm of the muscles of the hand ("obstetrician's hand") with passive extension of the arm (with spasmophilia, tetany) ... Encyclopedic Dictionary of Psychology and Pedagogy

This syndrome is named after the person who first established the relationship between the combination of thrombophlebitis and cancer of the internal organs - the French doctor Andre Trousseau. A typical symptom of spasmophilia is called by his name - "obstetrician's hand". Trousseau's syndrome refers to paraneoplastic processes, and links together spontaneous migrating thrombophlebitis and advanced cancer of the esophagus or other internal organs (usually the stomach, liver).

Paraneoplastic processes are the processes that occur in the body of the elderly and the elderly (they are much less common in young people), which develop with oncological diseases, but are in no way directly related to the tumor itself - that is, neither with its metastases, nor with its growth. Such non-specific reactions occur in response to those changes that arise due to the presence of an altered, neoplastic, essentially alien process for the body.

Causes

There are several causes of Trousseau's syndrome. One of them lies in the excessive formation of thrombogenic factors. Almost any tumor, starting from a small size, produces fibrinopeptide A, which, if detected, can be a marker of tumors in internal organs - this is due to the fact that quantitative indicators of fibrinopeptide A and tumor size are associated with a fairly high degree of accuracy.

The second reason is a change in hemostasis in cancer patients according to the type of an external coagulation mechanism - that is, after substances that are not part of it (in this case, tumor cells) enter the bloodstream. Tumors are a constant source of tissue thromboplastin, as well as a special "cancer procoagulant" that converts VII and X clotting factors into serine proteinase.

Most often, this symptom appears with tumors of the digestive tract.

Symptoms

As is often the case in medicine, the discovery of this syndrome is associated with the death of the author himself. André Trousseau has been dealing with neoplastic pathology for a long time, and has already noticed signs of spontaneous thrombosis in himself. Since the relationship between thrombosis and tumors was obvious to Trousseau, he suggested that he himself had it, especially since there were not too obvious, but, nevertheless, alarming symptoms. And so it turned out - Andre died of stomach cancer.

Tumors of internal organs do not always make themselves felt with typical symptoms. Yes, and people often tend to reduce the value of terrible, in their opinion, complaints and symptoms. The tumor grows, its external influence on the body increases, pareneoplastic processes are provoked. If phlebothrombosis is formed in different places, it is difficult to treat, or even not amenable at all, if there are thrombosis of large arteries not associated with any known diseases in this patient, it is worth assuming a cancerous tumor.

Diagnosis and treatment

Diagnosis must be thorough. Increased thrombotic processes, constant changes in blood counts, indicating changes in clotting factors. It is necessary to conduct a blood test for the presence of fibrinopeptide A and other coagulation factors, as well as pay attention to all non-specific complaints that the patient makes. It will also require a thorough diagnosis to identify the localization of the tumor.

There is no specific treatment for Trousseau's syndrome (as well as other paraneoplastic processes). They can only clinically weaken or regress with successful treatment (even palliative).

Forecast

It entirely depends on the prognosis of the tumor and the possibilities of its radical treatment.

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With a disorder of calcium-phosphorus metabolism that accompanies moderate or severe rickets, 4% of children develop spasmophilia, which is also called infantile tetany. This pathology is accompanied by a spastic state of the muscles of the limbs, face, larynx, as well as the occurrence of general clonic and tonic convulsions. It is detected, as a rule, between the age of three months and up to two years. One of the clearest manifestations of a developing disease are the symptoms of Khvostek, Trousseau and Lust, which help to determine the severity of the disease. How these symptoms are determined and how they are treated will be discussed later in the article.

How are spasmophilic symptoms tested?

To check for the presence of the Chvostek symptom, also called the phenomenon of the facial nerve, the child is placed on the bed without a pillow. At the same time, the legs should be straightened, and the arms should lie along the body.

The symptom is checked by light tapping with a percussion hammer or fingers at the exit of the trigeminal nerve (above the zygomatic arch). If the patient experiences an involuntary twitching of the eyelid and the corner of the upper lip, then the symptom mentioned is considered positive. By the way, it is checked on both cheekbones.

Khvostek's symptoms have 3 degrees of manifestation:

1. Muscle contraction throughout the region of innervation of the facial nerve.
2. Contraction of the muscles at the corner of the mouth and at the wing of the nose.
3. Muscle contraction only in the corner of the mouth.

In the presence of obvious tetany, the child manifests the first degree of the symptom even from a light touch in the area of ​​\u200b\u200bthe facial nerve.

Additional Ways to Check for Antispasmodic Symptoms

No less indicative in terms of determining the severity of the baby's condition are the symptoms of Trousseau and Lust.

• Trousseau's symptom is detected by compression of the middle of the child's shoulder. In this case, the doctor should try to capture as much of the soft tissues of his hand as possible. If as a result of this (approximately 2-3 minutes after squeezing) the patient's fingers take a forced position, called the "obstetrician's hands" (that is, the thumb is brought to the palm, the index and middle fingers are unbent, and the ring and little fingers are bent), then the symptom considered positive. To check for it in older children or adults, you can use a blood pressure cuff by pumping air into it until the pulse stops.
• Lust's symptom is checked with a hammer, which is tapped behind the head of the small muscle or by squeezing the calf muscle in the region of the Achilles tendon. If the patient has an involuntary abduction of the foot (“ballerina's foot”), then the symptom can be considered positive. It is tested on both limbs.

Symptoms of Chvostek, Trousseau, Lust are considered spasmophilic. They become positive if there is a change in the amount of calcium in the blood of a sick child, which is responsible for muscle contractions. This can lead not only to the presence of rickets, but also other diseases.

What is tetany

Chvostek's and Trousseau's symptoms are signs of spasmophilia (tetany). This disease is characterized by increased nervous excitability, manifested by the limbs or larynx. Most often, this pathology is observed in boys in the first six months of life.

And the biological basis of this disease is a low level of ionized calcium in the blood of a child.

What is the dangerous symptom of Khvostek in children

Photos of children with tetany make it possible to understand what are the signs of the disease. The main one is laryngospasm, which is expressed by difficulty in breathing, pallor of the face, sweating, and sometimes loss of consciousness. Periodic convulsions of the feet and hands (carpopedal spasm) are also characteristic, sometimes lasting several hours. Spasms of other muscle groups are also possible - respiratory, chewing, eye, etc.

But the most severe symptom of the disease is an attack of eclampsia - clonic-tonic convulsions, starting from the face and turning into cramps of the limbs and laryngospasm. In this case, the child most often loses consciousness, foam appears on the lips, involuntary urination is observed. Eclampsia is dangerous with the possibility of respiratory or cardiac arrest.

Who can get tetany

In the first days of life, convulsive conditions and hypocalcemia most often occur in babies born prematurely, in twins, as well as in those who have had jaundice or an infectious disease.

Chvostek's symptom in children of the first months of life can be triggered by both a decrease in the intake of calcium in the child's body and an increase in the secretion of calcitonin. Doctors also associate this condition with a violation of the supply of phosphorus and calcium with a sharp transfer of the baby to feeding with cow's milk, and also (in rare cases) with a lack of vitamin D and calcium in the mother's body.

Typically, in infants, hypocalcemia is manifested by neuromuscular excitability, convulsions, vomiting, tachycardia, and respiratory symptoms.

Treatment of tetany

Attacks of eclampsia require urgent assistance to the child, and in case of respiratory or cardiac arrest, resuscitation.

For any manifestations of tetany, anticonvulsants are prescribed to the child ("Sibazon" intramuscularly or intravenously, "Sodium oxybarbutyrate" intramuscularly, "Phenobarbital" rectally in suppositories or orally, etc.). Intravenous administration of 10% calcium gluconate solution or intramuscular 25% magnesium sulfate solution is also shown.

Spasmophilia causing Chvostek's and Trousseau's symptoms tends to have a favorable prognosis in most cases. The danger is only prolonged laryngospasm, threatening to stop breathing.

When a child reaches the age of 2-3 years, the pathological condition is eliminated as a result of stabilization of the level of calcium and phosphorus in the blood.

Hypoparathyroidism - a disease that is accompanied by a symptom of Chvostek

It is also a clear sign of a pathological condition called hypoparathyroidism, in which there is a decrease in functions. Most often, this problem occurs as a result of surgery for a disease of the thyroid gland or in the presence of an inflammatory process in it. And sometimes dysfunction can be caused by infectious processes, such as measles or influenza.

In newborns, hypoparathyroidism develops in the case of congenital absence of the parathyroid glands or when their functioning is suppressed by increased secretion of parathyroid hormone in the mother's body during pregnancy.

In this case, the patient, as a rule, has a decrease in the calcium content in the blood in parallel with an increase in the concentration of phosphorus. And outwardly, this is manifested by the already described tetany, intestinal phenomena, anomalies in the growth of teeth, nails and hair, as well as skin changes.

In such cases, the symptoms of Chvostek and Trousseau, along with laboratory tests, help to accurately identify the developed tetanic condition and diagnose the patient.

Treatment of hypoparathyroidism

For the treatment of this disease, it is important to consider the causes that caused its appearance, as well as the severity of the symptoms. In the acute course of the disease with symptoms of tetany, urgent administration of 10% calcium chloride or calcium gluconate intravenously is recommended. This is done slowly, taking into account the fact that the first mentioned solution contains 27% of the substance of the same name, and the second contains only 9%.

As a rule, in order to eliminate the symptoms of Chvostek, treatment with calcium preparations for at least 10 days is required. A good effect is the intake of calcium inside, and doctors advise doing this by dissolving the drug in milk to prevent the development of gastritis.

The chronic state of hypoparathyroidism requires the intake of vitamin D, starting with a loading dose (200-300 thousand units per day), with the obligatory control of the content of phosphorus and calcium in the blood, and after normalizing their level, the dose is reduced to 50 thousand units. per day in children up to a year or up to 125 thousand units. - in patients after a year.

What other diseases show the symptoms of Trousseau and Chvostek

In addition to diseases caused only by a decrease in calcium in the blood plasma for any reason, the symptoms of Chvostek, Trousseau and Lust can also be found in other ailments. These include:

• Neurasthenia with an anxious and suspicious state, manifested in the form of a patient, while experiencing a periodic disturbance in the rhythm of breathing, simulating suffocation, with a sensation of a lump in the throat, lack of air, and sometimes with loss of consciousness and convulsions.
• Discirculatory processes, combined with asthenic or astheno-neurotic syndrome, characterized by a state of constant fatigue and nervous exhaustion, as well as headache, sleep disturbances and dizziness.
• Hysteria, epilepsy and other diseases.

Prevention of calcium imbalance in a child

As you have probably already seen, in diseases that accompany the Chvostek symptom, in children, treatment comes down to the indispensable restoration of normal levels of calcium and phosphorus in the blood. Therefore, the prevention of these pathologies also requires, first of all, the control of the concentration of the mentioned substances, which is carried out by district pediatricians.

It is important to create optimal conditions for the development of the fetus in a pregnant woman. To do this, if the expectant mother lives in unsatisfactory social and living conditions or belongs to the risk group (diabetes mellitus, nephropathy, hypertension and rheumatism), she is prescribed vitamin D in the last 2 months of pregnancy. nutrition and physical activity.

And for a newborn to grow up strong and healthy, it is important to have breastfeeding, timely introduction of complementary foods, daily exposure to fresh air, free swaddling, massage, gymnastics and light-air baths.

Acute hypoparathyroidism- an acute pathological condition that develops as a result of insufficient incretion of parathyroid hormone by the parathyroid glands, which leads to a sharp decrease in the level of calcium in the blood, followed by attacks of tonic convulsions.

Tetany was first described by J. Clarke (1815). Tetany occurs at any age. It occurs not only with hypoparathyroidism, but also with a number of diseases and conditions without a decrease in the function of the parathyroid glands. The term "tetany" in contrast to "acute hypoparathyroidism" is a collective concept.

Etiology and pathogenesis of acute hypoparathyroidism

Acute hypoparathyroidism most often occurs due to accidental removal or injury of the parathyroid glands during thyroid surgery. The frequency of tetany after surgery on the thyroid gland ranges from 0.4 to 3.1% [Gurevich G. M., Mastbaum I. S., 1968]. According to other data, the frequency of tetany during resection of the thyroid gland is much higher and reaches 10% [Cherenko MP, 1977] and even up to 20.5%.

A hypocalcemic crisis can develop when a hyperfunctioning parathyroid adenoma is removed as a result of atrophy of other parathyroid glands. The frequency of tetany after parathyroid adenectomy is 50-67% [Nikolaev O. V., Tarkaeva V. N., 1974]. In a number of cases, tetany that appeared after removal of the parathyroid adenoma is functional and disappears with compensatory hyperplasia of the remaining parathyroid glands. Tetany may occur as a result of postoperative inflammation of the parathyroid glands or their autoimmune damage, as well as due to damage to the parathyroid glands by metastases of malignant neoplasms. The etiological factors of tetany can also be tuberculosis, measles, influenza [Jules M., Hollo I., 1967], amyloidosis of the parathyroid glands, treatment of toxic goiter with radioactive iodine. In some cases, tetany is a consequence of idiopathic hypoparathyroidism, the cause of which has not been finally established.

The cause of tetany may be a congenital inferiority of the parathyroid glands. With hidden insufficiency of the parathyroid glands, it can be detected as a result of infection, intoxication (poisoning with lead, carbon monoxide, ergot), D-hypovitaminosis, alkalosis, pregnancy, lactation, with insufficient absorption of calcium in the intestine.

Due to parathyroid hormone deficiency, the flow of calcium from bone tissue into the blood decreases and the reabsorption of phosphorus in the proximal tubules of the kidneys increases. This leads to hypocalcemia and hyperphosphatemia. A decrease in the calcium content in the blood leads to an imbalance between sodium and potassium ions, on the one hand, and calcium and magnesium, on the other. As a result, neuromuscular excitability sharply increases.

Tetany develops if the calcium content in the blood decreases to 1.25-1.75 mmol / l (5-7 mg%).

Clinic of acute hypoparathyroidism

Often an attack of tetany is preceded by precursors - coldness of the extremities, numbness, tingling and crawling, paresthesia and a feeling of spasms. Following the precursors, painful tonic convulsions develop, which more often affect symmetrical muscle groups and are selective.

Most often, cramps occur in the muscles of the upper limbs, less often in the lower ones. The flexor muscles are mostly affected. Due to spasm of the muscles of the face, a sardonic smile occurs, the lips take on the appearance of a “fish mouth”. With a spasm of the masticatory muscles, convulsive compression of the jaws (trismus) occurs. Cramps in the muscles of the upper extremities lead to the characteristic position of the hand: the fingers are compressed and slightly brought to the palm, the first finger is brought together, the hand is bent at the wrist joint ("obstetrician's hand"). With spasm of the muscles of the lower extremities, the thighs and lower legs are extended, the feet turn inward, the trunk arches backwards (opisthotonus). Due to convulsive contractions of the intercostal muscles, abdominal muscles and diaphragm, breathing is sharply disturbed.

In children, spasm of the muscles of the larynx is often observed, which leads to laryngospasm. With prolonged laryngospasm, asphyxia occurs and death occurs.

Changes in organs and systems during tetany depend on the predominance of the tone of the sympathetic or parasympathetic system. The predominance of the tone of the sympathetic system leads to tachycardia, increased blood pressure, pallor due to spasm of peripheral vessels, and the parasympathetic system leads to vomiting, bradycardia, lowering blood pressure, diarrhea, polyuria. Spasms of smooth muscles of internal organs and blood vessels can simulate cardiovascular diseases (attacks of angina pectoris, endarteritis, migraine, etc.), respiratory diseases (bronchial asthma, etc.), gastrointestinal tract (cholecystitis, pancreatitis, appendicitis) , stomach ulcer, etc.), genitourinary system (cystitis, nephritis, etc.). The ECG shows a prolongation of the Q-T interval, which is associated with hypocalcemia.

Attacks of compressive pain behind the sternum and in the region of the heart such as angina pectoris are isolated as a kind of pseudoanginous form of tetany [Kyrge K. X., 1956; Quandt J., 1954, etc.]. The cardiac form of tetany can result in death as a result of convulsive contraction of the heart muscle or spasm of the coronary vessels. In some cases, a spasm of the spinal vessels occurs, resulting in the development of toxic-vascular myelopathy (girdle pain in the thoracic spine, numbness in the legs, increasing weakness in them to the degree of paraparesis, etc.) [Martynov Yu. S. et al. , 1973].

Spasms of the digestive organs, occurring under the guise of cholecystitis, appendicitis, pancreatitis, etc., in some cases can lead to unreasonable surgical intervention. An attack of seizures can last from several minutes to several hours. Consciousness in a hypocalcemic crisis is usually preserved. In severe attacks of tetany, there is a loss of consciousness, which, in combination with convulsions, makes them similar to epileptic seizures. On the EEG in these patients, as in epilepsy, peak-wave complexes (peaks, sharp waves, isolated or in combination with a subsequent slow wave) are noted. Under the influence of treatment, these changes may completely or partially disappear. Sometimes patients with tetany experience acute psychosis, cerebral edema, stem and extrapyramidal symptoms.

During an attack of tetany, diplopia may occur due to temporary strabismus or impaired convergence.

With a mild form of hypoparathyroidism, tetany attacks are rare (1-2 times a week), their duration does not exceed a few minutes. In a severe form of hypoparathyroidism, attacks are frequent (sometimes several times a day), last several hours and easily arise under the influence of external stimuli (mental and physical trauma, hypothermia, overheating, etc.). The acute form of hypoparathyroidism has a severe course. Attacks of tonic convulsions often recur and are protracted.

Laboratory data. For rapid diagnosis of hypocalcemic crisis, the determination of the level of calcium in the blood is used. There is a decrease in the level of total calcium to 1.9 mmol/l (7.5 mg%) and below, and ionized - up to 1.1 mmol/l (4.3 mg%) and below. The calcium content in the blood usually corresponds to the severity of tetany. In severe form, its calcium content in the blood decreases to 1.5-1.2 mmol / l (6-5 mg%) and below. Characterized by hyperphosphatemia. Hypocalciuria and hypophosphaturia are noted.

For an approximate judgment about the content of calcium in the blood, the Sulkovich test is used (see the section "Acute hyperparathyroidism"). In the urine, calcium is not determined when its content in the blood is below 2-1.75 mmol / l (8-7 mg%).

To diagnose a hypocalcemic crisis that occurs with a predominance of symptoms of autonomic dysfunction and viscerovascular pathology and latent tetany, tests based on increased mechanical, are used. thermal and electrical excitability of the neuromuscular apparatus.

When tapping with a finger or a percussion hammer along the facial nerve in front of the tragus of the auricle (at the exit point of the facial nerve), a tail symptom is detected. This symptom can be I, II or III degree. The contraction of the muscles of the entire area innervated by the facial nerve is characteristic of overt tetany and is designated as "Tail-I". With "Kvostek-P" there is a contraction of the muscles in the area of ​​​​the wing of the nose and the corner of the mouth, and with "Khvostek-III" - only the muscles of the corner of the mouth contract. Tail-P and Tail-Sh are usually found in latent tetany.

Trousseau's symptom is detected by pulling the patient's shoulder with a rubber tourniquet or rubber cuff until the pulse disappears for 2-3 minutes. With hidden tetany, after a specified time, a convulsive reaction of the hand in the form of an "obstetrician's hand" occurs in the constricted limb.

Schlesinger's symptom is detected with rapid passive flexion in the hip joint of the patient's leg, straightened at the knee joint. With hidden tetany, a convulsive contraction of the extensor muscles of the thigh appears with a sharp supination of the foot. The contraction of the muscles of the limbs under the influence of a galvanic current of even a small force (0.7 mA) is called Erb's symptom.

Diagnosis and differential diagnosis of acute hypoparathyroidism

The diagnosis of acute hypoparathyroidism is established on the basis of anamnesis (the occurrence of attacks of tetany after surgery on the thyroid gland, removal of parathyroid adenoma, treatment of toxic goiter with radioactive iodine, etc.), characteristic clinical symptoms (local painful tonic convulsions affecting symmetrical muscle groups - trismus, opisthotonus etc., difficulty in breathing, convulsive spasms of the whole body, etc.), laboratory data (hypocalcemia, hyperphosphatemia) and diagnostic tests (symptoms of Khvostek, Trousseau, Erb). Of particular importance in the diagnosis of acute hypoparathyroidism are symptoms that indirectly indicate chronic hypoparathyroidism: dry skin, brittleness and striation of nails, defects in tooth enamel, caries, central or subcapsular cataracts, nested or total baldness, early graying of hair, symmetrical calcification of the vascular plexuses and other vessels of the brain, calcification of the basal ganglia, etc.

Seizures in acute hypoparathyroidism are differentiated primarily from other hypocalcemic tetany not associated with the primary pathology of the parathyroid glands. Tetany in these cases may result from impaired intestinal absorption of calcium due to vitamin D deficiency (spasmophilia, adult rickets). The cause of tetany can also be various diseases and conditions accompanied by impaired absorption of calcium in the intestine due to steatorrhea (sprue, chronic pancreatitis, diarrhea after resection of a large area of ​​the small intestine, chronic enteritis, etc.). In some cases, such tetany develops due to an increased need for calcium and vitamin D during pregnancy and lactation. Hypocalcemic tetany can also be observed after oxalate poisoning.

Unlike tetany in acute hypoparathyroidism, the above tetany is characterized not only by hypocalcemia, but also by hypophosphatemia. The only exception is tetany after oxalate poisoning, which is characterized by hypocalcemia and a normal content of phosphorus in the blood. The cause of hypocalcemia in this case is calcium inactivation due to the formation of insoluble calcium oxalate compounds.

Hypocalcemic tetany, but with hyperphosphatemia, is observed in a congenital disease - Albright's disease, which, due to the insensitivity of the renal tubules to parathyroid hormone, is called pseudohypoparathyroidism. Patients with pseudohypoparathyroidism are characterized by short stature, short bones, often severe mental retardation and a tendency of the subcutaneous tissue to calcify and ossify.

Hypocalcemia with hyperphosphatemia, but usually without tetany, is seen in chronic renal failure. The absence of tetany in this form of hypocalcemia is due to acidosis due to hyperazotemia and hypermagnesemia, however, when the acid-base state shifts to the alkaline side, calcium ionization decreases and tetany may occur. Sometimes hypocalcemic tetany develops due to a deficiency in the body of magnesium. The latter contributes to the suppression of calcium mobilization from bone tissue by parathyroid hormone. Hypo-magnesemia can be with severe eating disorders due to malabsorption in the intestine, after prolonged parenteral nutrition, with chronic alcoholism, etc.

Tetany with a normal content of calcium and phosphorus in the blood is observed with alkalosis (gastric and hyperventilation tetany) and citrate poisoning. Gastric tetany occurs after prolonged vomiting and loss of hydrochloric acid, as well as after taking large amounts of sodium bicarbonate, resulting in a decrease in the concentration of ionized calcium in the blood. However, the total level of calcium in the blood remains within the normal range. Hyperventilation tetany is due to increased release of CO 2, resulting in alkalosis. Hyperventilatory tetany (after frequent and deep respiratory movements) is observed in hysteria and less often in patients with encephalitis.

Tetany in citrate poisoning is due to calcium inactivation due to the formation of calcium citrate.

M. Yules and I. Hollo (1967) proposed the following scheme for the differential diagnosis of tetany not associated with the primary pathology of the parathyroid glands (Scheme 1).

Tetanies can be of iatrogenic origin (the introduction of large doses of calcitonin, mithramycin, EDTA, glucagon, phosphorus salts, long-term use of phenobarbital, which disrupts the metabolism of vitamin D, etc.).

Attacks of convulsions in acute hypoparathyroidism diffetania due to organic diseases of the central nervous system (rheumatism, brain tumor, etc.), primary hyperaldosteronism, tetanus, rabies, strychnine poisoning.

In contrast to the hypocalcemic crisis in epilepsy, the symptoms of Khvostek, Trousseau, Erb are usually negative and phosphorus-calcium metabolism is not disturbed. The anamnesis, a characteristic feeling of hunger, a normal calcium content in the blood in the presence of hypoglycemia testify to the hypoglycemic genesis of seizures.

In tetany syndrome caused by organic diseases of the central nervous system, in contrast to tetany in acute hypoparathyroidism, there is no violation of phosphorus-calcium metabolism and changes in acid-base balance.

The characteristic symptoms of the disease speak of primary hyperaldosteronism: attacks of severe muscle weakness, transient flaccid paralysis, arterial hypertension, polyuria, polydipsia, hypokalemia, etc. The calcium content in the blood is within normal limits.

We can talk about tetanus and against a hypocalcemic crisis based on the history (presence of trauma and contamination of the wound with earth) and the widespread nature of convulsions, usually starting from the masticatory muscles and capturing other muscles in a certain sequence (mimic muscles, muscles of the neck, trunk, lower extremities). In contrast to the hypocalcemic crisis in tetanus, the calcium content in the blood is within the normal range.

Anamnesis (bite, salivation of an infected animal) and a characteristic clinical picture (hydrophobia, aerophobia, agitation, sometimes bouts of violence, followed by paralysis of the muscles of the limbs, tongue, increased salivation, etc.) indicate the presence of rabies and the absence of a hypocalcemic crisis.

In case of strychnine poisoning, in contrast to the hypocalcemic crisis, the symptoms of Khvostek and Trousseau are negative, the calcium content in the blood is normal.

Prognosis of acute hypoparathyroidism

With timely and correct replacement therapy, the prognosis for life is usually favorable. With laryngospasm and cardiac form of tetany, the prognosis is serious (death can occur due to asphyxia, convulsive contraction of the heart muscle or spasm of the coronary vessels).

Prevention. Prevention of acute hypoparathyroidism consists in the maximum sparing of the parathyroid glands during operations on the thyroid gland, as well as in the prevention of complications (adhesions, infiltrates, etc.) that disrupt their blood supply after surgery.

Early detection of neuromuscular excitability in patients after thyroid surgery is necessary, followed by immediate rational specific therapy. Preventive measures should be aimed at preventing infections and intoxications that damage the parathyroid glands, as well as factors provoking the development of an acute hypocalcemic crisis in patients with chronic hypoparathyroidism. In order to prevent tetany, patients with hypoparathyroidism are prescribed a diet rich in calcium and poor in phosphorus.

Treatment of acute hypoparathyroidism

1. To stop an acute attack of tetany, depending on the severity of the attack, 10-50 ml of a 10% solution of calcium chloride or calcium gluconate is administered intravenously. The effect of the drug appears already at the end of the injection. If necessary, intravenous administration of calcium preparations is repeated 3-4 times a day.

2. After the introduction of calcium preparations to prevent attacks of tetany, 40-100 units of parathyroidin are injected subcutaneously or intramuscularly. Parathyroidin - an extract of the parathyroid glands of cattle - contains 20 IU of the active principle in 1 ml. The therapeutic effect after its administration occurs after 2-3 hours and lasts 20-24 hours. The maximum increase in the level of calcium in the blood after the administration of the drug occurs after 18 hours.

3. After elimination of convulsions, instead of parathyroidin or simultaneously with it, dihydrotachysterol (AT-10) is prescribed at a dose of 2 mg orally after 6 hours. In the future, every 2 days, its dose is reduced by 2 mg. The maintenance dose is usually 2 mg. Dihydrotachysterol not only promotes the absorption of calcium by the intestines, but, like parathyroid hormone, promotes the mobilization of calcium from the bones and the excretion of phosphorus in the urine. Treatment with dihydrotachysterol, as well as with parathyroidin, is carried out under the systematic control of the level of calcium in the blood and its excretion in the urine. The duration of the drug after its withdrawal is 10 days. For better intestinal absorption of calcium, ergocalciferol (vitamin D2) can be used instead of dihydrotachysterol. To eliminate attacks of tetany, vitamin D2 (alcohol solution) is prescribed at 200,000-400,000 IU per day, followed by a gradual decrease in the dose after the cessation of attacks to 25,000-50,000 IU per day. Treatment with vitamin D2 is carried out under systematic monitoring (1-2 times a month) of the level of calcium in the blood.

4. Assign sedatives and antispasmodics (bromides, luminal, chloral hydrate orally or in an enema, papaverine, etc.).

5. To eliminate alkalosis, ammonium chloride is used, 3-7 g per day.

6. With increasing laryngospasm, intubation or tracheotomy is indicated.

Potemkin V.V. Emergency conditions in the clinic of endocrine diseases, 1984