Cause Of Tetany Research Articles

Spectrum of Disorders associated with Tetany.

Awareness regarding the etiological spectrum of tetany is poor among physicians. Because of poor awareness, tetany is underdiagnosed and undertreated. Databases like PubMed, PubMed Central, Scopus, and Google Scholar are searched to identify peer-reviewed articles on tetany. Case reports, case series, and original articles are analyzed to identify different causes of tetany prevalent in the community. Different causes found are analyzed and tabulated, and finally, a flowchart is made on the approach for diagnosing different underlying pathologies of tetany. Both metabolic and respiratory alkalosis are important causes of tetany because of reduced ionized calcium levels. Gitelman syndrome (GS) is associated with metabolic alkalosis, hypokalemia, hypomagnesemia and hypocalciuria, and frequently causes normocalcemic tetany. Recurrent vomiting and primary hyperaldosteronism also cause tetany due to metabolic alkalosis. Hyperventilation syndrome (HVS) leads to respiratory alkalosis and is a frequent cause of tetany. Hyperventilation-induced tetany is also seen after spinal anesthesia and in respiratory disorders like asthma. Vitamin D deficiency (VDD), primary hypoparathyroidism, and pseudohypoparathyroidism (PHP) (1a, 1b, and 2) cause hypocalcemic tetany. Hypomagnesemia causes hypocalcemia and tetany due to peripheral parathyroid hormone resistance and impaired parathyroid hormone secretion. Drugs causing tetany include bisphosphonates, denosumab, cisplatin, antiepileptics, aminoglycosides, diuretics, etc. Tetany is also seen in acute pancreatitis, dengue, falciparum malaria, hyperemesis gravidarum, tumor lysis syndrome (TLS), massive blood transfusion, etc. Conclusion: The spectrum of disorders associated with tetany is diverse. Awareness of different causes will help early and proper diagnosis of tetany.

A Study of Tetany among the Saudi Population

Aim of the work: studies mentioning etiological distribution of tetany are rare and responsiveness concerning it is poor among physicians so, we tried to describe different causes of tetany beyond the decrease in total serum calcium level. Methods: patients with overt or latent tetany were assessed clinically and from laboratory investigations. Initial examinations completed were serum calcium, potassium and arterial blood gas analysis. Both ionized and total calcium were evaluated and corrected according to serum albumin level. Depending on initial reports, additional tests were completed for example, alkaline phosphatase, serum phosphate, parathyroid hormone and magnesium levels; and urine potassium, calcium and chloride levels. Results: Gitelman’s syndrome (GS), Bartter’s syndrome (BS), recurrent vomiting, anxiety hyperventilation, vitamin D3 deficiency (VDD), idiopathic hypoparathyroidism (IHP), postoperative hypoparathyroidism (PHP), acute pancreatitis, tumor lysis syndrome (TLS) and hypomagnesemia were the different causes of tetany identified. Out of 106 patients, total serum calcium was normal in 82 patients with metabolic or respiratory alkalosis (GS, BS, recurrent vomiting, and anxiety hyperventilation). Total calcium was low only in 24 patients (in VDD, IHP, PHP, acute pancreatitis, TLS and hypomagnesemia). Ionized calcium was low in all patients. GS was the most common (38%). Recurrent vomiting (19%), anxiety hyperventilation (13%), and VDD (11%) were also common. PHP was less common (4%); acute pancreatitis, TLS, hypomagnesemia and IHP were uncommon. Conclusion: tetany has diverse etiologies. Both metabolic and respiratory alkalosis caused a decrease in ionized calcium and are responsible for the majority of cases of tetany. Causes other than decreased total calcium should be kept in mind for early etiological diagnosis of tetany.

Etiological spectrum of tetany in a teaching institution of western part of West Bengal - A cross-sectional study

Introduction: Studies describing etiological distribution of tetany are rare, and awareness regarding it is poor among physicians. Our study describes different causes of tetany beyond the decrease in total serum calcium level. Methods: Patients with overt or latent tetany were evaluated clinically and from laboratory investigations. Initial investigations done were serum calcium, potassium, and arterial blood gas analysis. Both ionized and total calcium were assessed and corrected according to serum albumin level. Depending on initial reports, further tests were done such as serum phosphate, alkaline phosphatase, parathyroid hormone and magnesium levels; and urine potassium, calcium and chloride levels. Results: Gitelman's syndrome (GS), Bartter's syndrome (BS), recurrent vomiting, anxiety hyperventilation, Vitamin D3deficiency (VDD), idiopathic hypoparathyroidism (IHP), postoperative hypoparathyroidism (PHP), acute pancreatitis, tumor lysis syndrome (TLS), and hypomagnesemia were the different causes of tetany identified. Out of 53 patients, total serum calcium was normal in 41 patients with metabolic or respiratory alkalosis (GS, BS, recurrent vomiting, and anxiety hyperventilation). Total calcium was low only in 12 patients (in VDD, IHP, PHP, acute pancreatitis, TLS, and hypomagnesemia). Ionized calcium was low in all patients. GS was the most common (38%). Recurrent vomiting (19%), anxiety hyperventilation (13%), and VDD (11%) were also common. PHP was less common (4%); acute pancreatitis, TLS, hypomagnesemia, and IHP were uncommon. Conclusion: Tetany has diverse etiologies. Both metabolic and respiratory alkalosis cause decrease in ionized calcium and are responsible for the majority of cases of tetany. Causes other than decreased total calcium should be kept in mind for early etiological diagnosis of tetany.

Potassium/Magnesium Ratio Effects on Aluminum Tolerance and Mineral Composition of Wheat Forage

AbstractKnowledge of cation amelioration of Al toxicity may improve our understanding of differential Al‐tolerance mechanisms among winter wheat (Triticum aestivum L.) forage genotypes, and the causes of tetany in grazing cattle. A solution culture experiment was conducted using two winter wheat cultivars (Atlas 66 and Scout 66), two Al levels (0 and 50 μM), and three K/Mg ratios (0.1, 0.7 and 2.3, on a mol Lc−1 basis). Root dry weights were decreased significantly by Al for Al‐sensitive Scout 66, but not for Al‐tolerant Atlas 66. Increasing the K/Mg ratio in the presence of Al significantly decreased root dry weight, root length, and the root tolerance index for Scout 66, but not for Atlas 66. Shoot and root Mg concentrations were always significantly lower for Scout 66 than for Atlas 66. Without Al, shoot K and Ca concentrations for the two cultivars were not significantly different. With Al, shoot K, Ca and Mg concentrations were depressed more for Scout 66 than for Atlas 66. The K(Ca + Mg) ratios increased significantly in Scout 66 with added Al, thereby causing an increased tetany hazard. Adding Al reduced shoot Cu and Zn concentrations in both cultivars, and Fe and Mn concentrations in Scout 66. Increasing the proportion of Mg in solution increased the Al tolerance for Scout 66, indicating that an appropriate K/Mg ratio is important in selecting for Al‐tolerant wheat cultivars.

Wheat pasture poisoning. II. Tissue composition of cattle grazing cereal forages and related to tetany.

Thirty-two aged Hereford and Angus cows (avg 10.2 yr old) grazed mixed cereal (wheat and rye) pastures from December 6, 1979 to April 23, 1980 (138 d). On d 104 (March 19), five cows developed tetany. On the day of tetany, the mean plasma Ca of the cows with tetany was 4.1 mg/dl. Cows with tetany had plasma Mg concentrations of 1.7 mg/dl on the day of tetany, but 15 d before tetany and 6 d post-tetany, levels were lower (1.2 mg/dl). Cows with tetany had large increases in plasma parathyroid hormone (PHT) as well as vitamin 1, 25 dihydroxy D3 [1,25(OH)2D], plasma glucose, lactic acid and beta-hydroxybutyric acid. Plasma K of these cows followed a similar trend as plant K, except it was not as pronounced. Plasma inorganic P of these same cows was exceedingly low, less than 3 mg/dl several times, although the forage P did not indicate a P deficiency. Levels of plasma hydroxyproline in these cows indicated that bone resorption may have been low during most of the grazing season, even though levels of plasma hydroxyproline were initially high and high subsequent to tetany. High levels of plasma glucose and lactic acid were associated with the time of tetany. Apparently, cows developed inappetence around the time of tetany, as suggested by the high levels of plasma beta-hydroxybutyric acid. Cows with wheat pasture poisoning appeared to respond to the severe hypocalcemia with large increases in plasma 1,25(OH)2D. Plasma 1,25(OH)2D changes were similar to plasma hydroxyproline changes (and possible bone resorption rates) and seemed inversely proportional to plasma Ca and directly proportional to plasma PTH concentrations. Generally, cerebrospinal fluid (CSF) composition was not affected as much as plasma composition, except for the low levels of CSF Ca. These data indicate that a metabolic deficiency of Ca (hypocalcemia) was the cause of tetany.

Characteristics of spinal reflexes in experimental hypoparathyroidism

Experiments on parathyroidectomized cats with motor disorders of different degrees of severity showed disturbance of spinal reflex activity, in the form of activation of motoneurons and the interneuron system, weakening of posttetanic potentiation, and facilitation of conduction in the reflex arc. If severe tetany was present monosynaptic responses were reduced or, in some cases, abolished completely and polysynaptic reflex discharges were potentiated. After intravenous injection of calcium chloride into the experimental animals a tendency was found for recordable reflexes to return. It is concluded that disturbance of the functional state of the spinal segmental apparatus was largely due to hypocalcemia and it may be one of the causes of tetany in hypoparathyroidism.

CHANGES IN SERUM CALCIUM, SERUM PHOSPHATE AND RED-CELL PHOSPHATE DURING HYPERVENTILATION.

IN their recent experiments on hyperventilation Saltzman et al.1 found no significant changes in the serum calcium, but in the early work on hyperventilation as a cause of tetany, Grant and Goldman2 observed an increase in the serum calcium in response to hyperventilation. Later, McCance3 reported a rise of the serum calcium of 0.5 mg. per 100 ml. during an episode of hyperventilation in 1 patient but no change in another.We have performed experiments on hyperventilation in 15 men (forceful hyperventilation for thirty minutes to produce the most severe tetany feasible). Data on 7 of these were reported earlier. . . .

CHEMICAL CHANGES IN THE BODY OCCURRING AS THE RESULT OF VOMITING

Although considerable attention has been given to the occurrence and significance of acidosis, it is only recently that changes of body neutrality to the alkaline side have received much notice. 1 REVIEW OF THE LITERATURE Wilson and his co-workers 2 were among the first to consider alkalosis as a possible cause of tetany. They found, following parathyroidectomy, that there was a slight increase in the p H or alkalinity of the blood, a change in the hemoglobin dissociation curve and a rise in alveolar carbon dioxide tension. Accompanying these changes there was found also an increase in urinary p H (alkalinity) with diminished ammonia and acid excretion. It was further assumed that with the onset of tetany, the acid products of muscular contraction were sufficient to change this primary increased alkalinity to a normal or more acid reaction. In 1918, McCann 3 reported chemical analyses of the blood following parathyroidectomy,