Saturday, August 16, 2025

Tetany

Tetany: Causes, Symptoms, Diagnosis, Treatment, and Prevention

~Introduction

Tetany is a medical condition characterized by intermittent, involuntary muscle spasms, cramps, or tremors caused by increased excitability of the nerves and muscles. It often results from disturbances in electrolyte balance, particularly low levels of calcium, magnesium, or potassium in the blood. The spasms may affect the hands, feet, face, and sometimes the larynx (voice box), which can become a life-threatening emergency if breathing is compromised.

While tetany is not a disease itself, it is a clinical manifestation of underlying conditions, most commonly hypocalcemia (low calcium levels). Early recognition and management are crucial, as untreated tetany may lead to complications such as seizures, cardiac arrhythmias, and respiratory distress.

~What is Tetany?

The term tetany refers to a state of increased neuromuscular excitability. It occurs when nerve cells become overly sensitive due to low levels of calcium or other electrolytes, causing them to fire spontaneously and repeatedly. This hyperactivity stimulates muscle contractions, resulting in spasms and cramps.

Tetany differs from tetanus:

Tetany is caused by metabolic and electrolyte imbalances.
Tetanus is an infectious disease caused by Clostridium tetani bacteria producing a neurotoxin.

~Causes of Tetany

Several factors can lead to tetany, most of which involve abnormalities in electrolyte or metabolic balance:

1. Hypocalcemia (Low Calcium Levels)

The most common cause of tetany.
May result from:
- Hypoparathyroidism (low parathyroid hormone).
- Vitamin D deficiency.
- Chronic kidney disease.
- Acute pancreatitis.
- Malabsorption disorders (celiac disease, Crohn’s disease).

2. Hypomagnesemia (Low Magnesium Levels)

Magnesium is essential for parathyroid hormone (PTH) release and calcium regulation.
Low magnesium levels can cause hypocalcemia and nerve excitability.
Causes include alcoholism, malnutrition, prolonged diarrhea, and certain medications (diuretics, proton pump inhibitors).

3. Hypokalemia (Low Potassium Levels)

Leads to muscle weakness and spasms, contributing to tetany.

4. Alkalosis (High Blood pH)

Hyperventilation-induced respiratory alkalosis decreases ionized calcium levels, precipitating tetany.

5. Other Causes

After thyroid or parathyroid surgery (postoperative hypocalcemia).
Certain medications (cisplatin, amphotericin B).
Rare genetic disorders affecting calcium metabolism.

~Symptoms of Tetany

The severity of symptoms ranges from mild tingling sensations to severe, painful muscle contractions.

Early Symptoms

Tingling or numbness around the mouth, fingers, and toes.
Muscle twitches in the face or extremities.

Classic Signs

Carpopedal Spasm – Painful contractions of the hands and feet, causing them to curl inward (“obstetrician’s hand” sign).
Facial Spasm (Chvostek’s Sign) – Twitching of facial muscles when the facial nerve is tapped.
Trousseau’s Sign – Hand spasm induced by inflating a blood pressure cuff on the arm.

Severe Symptoms

Generalized muscle cramps and spasms.
Seizures.
Difficulty breathing due to laryngeal spasm (laryngospasm).
Cardiac arrhythmias due to electrolyte imbalance.

~Complications of Tetany

If untreated, tetany can lead to:

Respiratory distress due to laryngospasm.
Seizures.
Irregular heart rhythms (potentially fatal).
Chronic neuromuscular problems if underlying condition persists.

~Diagnosis of Tetany

Tetany is diagnosed through a combination of clinical signs and laboratory tests:

History and Physical Examination
- Presence of spasms, numbness, or tingling.
- Positive Chvostek’s and Trousseau’s signs.
Laboratory Investigations
- Serum calcium (total and ionized calcium levels).
- Serum magnesium and potassium levels.
- Blood pH (to check for alkalosis).
- Parathyroid hormone (PTH) levels.
- Vitamin D levels.
- Renal and liver function tests.
Electrocardiogram (ECG/EKG)
- To detect cardiac arrhythmias associated with hypocalcemia or hypomagnesemia.

~Treatment of Tetany

Treatment depends on the underlying cause, but emergency management often requires rapid correction of electrolyte imbalances.

1. Immediate/Emergency Management

Intravenous Calcium Gluconate or Calcium Chloride: To rapidly restore calcium levels.
IV Magnesium Sulfate: In cases of hypomagnesemia.
Potassium Supplements: If hypokalemia is the cause.
Oxygen and Ventilation Support: In cases of laryngospasm or respiratory distress.

2. Long-Term Management

Oral Calcium and Vitamin D Supplements: To maintain calcium balance.
Treatment of Underlying Conditions:
- Hypoparathyroidism: Lifelong supplementation.
- Kidney disease: Management of electrolyte abnormalities.
- Gastrointestinal malabsorption: Dietary modifications and supplementation.
Lifestyle Modifications: Balanced diet rich in calcium and magnesium, reduced alcohol intake, and avoiding excessive diuretics without medical advice.

~Prevention of Tetany

Dietary Measures
- Adequate intake of calcium (milk, cheese, leafy greens) and magnesium (nuts, seeds, whole grains).
- Vitamin D through sunlight exposure and fortified foods.
Medical Check-Ups
- Regular monitoring of calcium and vitamin D levels in at-risk individuals.
- Post-thyroid or parathyroid surgery patients should be closely monitored for hypocalcemia.
Managing Underlying Disorders
- Control of chronic kidney disease, gastrointestinal disorders, and endocrine problems.
Avoiding Triggers
- Preventing hyperventilation during anxiety or panic attacks (which can cause alkalosis).

~Difference Between Tetany and Tetanus

Feature	Tetany	Tetanus
Cause	Electrolyte imbalance (low calcium, magnesium, etc.)	Bacterial infection (Clostridium tetani)
Onset	Sudden, due to metabolic changes	Gradual, after wound infection
Muscles Affected	Intermittent spasms, mainly in hands, feet, face	Generalized stiffness, lockjaw, body rigidity
Treatment	Electrolyte replacement, supplements	Antibiotics, antitoxin, supportive care
Prevention	Balanced diet, managing conditions	Vaccination (tetanus toxoid)

~Conclusion

Tetany is a serious neuromuscular condition caused primarily by disturbances in calcium, magnesium, or potassium balance. While it may present with mild tingling and spasms, it can progress to life-threatening complications such as seizures, arrhythmias, and respiratory distress.

Early recognition, immediate electrolyte correction, and treatment of the underlying cause are essential. Preventive strategies such as a nutrient-rich diet, vitamin D supplementation, regular health check-ups, and careful monitoring of patients after thyroid or parathyroid surgery play a key role in reducing the risk of tetany.

By understanding its causes, recognizing early warning signs, and seeking timely treatment, individuals can avoid severe outcomes and maintain healthy neuromuscular function.

Health Lines