Assuntos
Cálcio/sangue , Cesárea , Hipocalcemia/sangue , Hipocalcemia/complicações , Tetania/sangue , Tetania/complicações , Doença Aguda , Adulto , Gluconato de Cálcio/sangue , Gluconato de Cálcio/uso terapêutico , Feminino , Humanos , Hipocalcemia/tratamento farmacológico , Gravidez , Tetania/tratamento farmacológico , Adulto JovemRESUMO
A serum calcium level >3.5 mmol/l together with clinical symptoms such as muscle weakness, fatigue, nausea, vomiting, pancreatitis or even coma are characteristic for a hypercalcemic crisis (HC). Primary hyperparathyroidism (1HPT) and malignancy-associated hypercalcemia are the most frequent causal diseases for a HC. The analysis of serum levels for calcium, phosphorous, intact parathyroid hormone, electrophoresis and renal function parameters indicate which further radiological, scintigraphic or serum diagnostic steps are adequate to identify the cause of the patient's acute situation (i. e. most frequently 1HPT or malignant disease with bone involvement, e. g. myeloma) and thus to initiate the required surgical or oncological intervention. However, the primary goals in the treatment of HC include correcting dehydration and improving kidney function, lowering calcium levels and decreasing osteoclastic bone resorption. The goals are accomplished by volume repletion, forced diuresis, antiresorptive agents and hemodialysis on an intensive care unit. Hypocalcemic tetany (HT) is the consequence of severely lowered calcium levels (<2.0 mmol/l), usually in patients with chronic hypocalcemia. The causal disease for hypocalcemic tetany is frequently a lack of parathyroid hormone (PTH), (e. g. as a complication of thyroid surgery) or, rarely, resistance to PTH. HT due to severe and painful clinical symptoms requires rapid i. v. calcium replacement by central venous catheter on an intensive care unit. For the treatment of chronic hypocalcemia oral calcium and 25OH-vitamin D or even 1,25(OH)2-vitamin D3 and magnesium supplements may be necessary to achieve the desired low normal calcium levels. Thiazides are useful to reduce renal calcium loss and to stabilize the calcium levels. Some patients continue to exhibit clinical symptoms despite adequate calcium levels; in these cases s. c. parathyroid hormone 1-84 should be considered to stabilize calcium levels and to lower the dosage of calcium and vitamin D supplements.
Assuntos
Coma/diagnóstico , Distúrbios do Sono por Sonolência Excessiva/diagnóstico , Hipercalcemia/diagnóstico , Hipocalcemia/diagnóstico , Debilidade Muscular/diagnóstico , Tetania/diagnóstico , Cálcio/sangue , Coma/sangue , Coma/terapia , Diagnóstico Diferencial , Distúrbios do Sono por Sonolência Excessiva/sangue , Distúrbios do Sono por Sonolência Excessiva/terapia , Humanos , Hipercalcemia/sangue , Hipercalcemia/etiologia , Hipercalcemia/terapia , Hiperparatireoidismo Primário/sangue , Hiperparatireoidismo Primário/diagnóstico , Hipocalcemia/sangue , Hipocalcemia/etiologia , Hipocalcemia/terapia , Debilidade Muscular/sangue , Debilidade Muscular/terapia , Neoplasias/sangue , Neoplasias/complicações , Neoplasias/terapia , Tetania/sangue , Tetania/terapiaRESUMO
Tetany is the abnormal state of increased neuromuscular excitability. It is manifested with muscle cramps and spasms, usually associated with abnormal calcium metabolism. This state can be devided into two main types: tetany with clinical manifestaton (hypocalcemic) and occurred more frequently latent tetany (normocalcemic). In this study was presented the case of a child with electrophysiological and clinical manifestation of latent tetany. We report a case of a female patient who was admitted to the Pediatric Neurology Department in the year 2015. Some clinical, biochemical and neurophysiological results have been analyzed.
Assuntos
Tetania/fisiopatologia , Criança , Fenômenos Eletrofisiológicos , Feminino , Humanos , Convulsões , Tetania/sangue , Tetania/diagnósticoRESUMO
A requisition for two units of packed red blood cells was received for a 54 year female, known case of genitourinary carcinoma. After transfusion of approximately 15-20 ml of blood, a call was received from resident in charge of radiotherapy ward stating that patient had clenching of hands along with circumoral tingling and paresthesias in her limbs. Her investigations showed decreased serum potassium and calcium levels but serum magnesium levels were not available. Multiple electrolyte disturbances probably precipitated tetany even by small volume of blood transfusion. We therefore recommend careful monitoring of electrolytes, including magnesium, before starting blood transfusion.
Assuntos
Tetania/etiologia , Reação Transfusional , Feminino , Humanos , Pessoa de Meia-Idade , Tetania/sangueRESUMO
38 year old woman was admitted with acute onset of quadriplegia. Biochemical investigation revealed severe hypokalaemia with hyperchloraemic metabolic acidosis, alkaline urine, and positive urinary anion gap which are the hallmark of distal tubular acidosis. In addition she also had hypophosphataemia, normoglycaemic glycosuria, aminoaciduria, and hyperphosphaturia suggestive of proximal tubular dysfunction. Further evaluation confirmed the diagnosis of Sjogren's syndrome. Interestingly our patient also had carpopedal spasm despite normal calcium and magnesium level. Quadriplegia and carpopedal spasm improved with correction of hypokalaemia and acidosis. Proximal tubular abnormalities (except albuminuria) were normalised at the time of discharge. Distal tubular acidosis is a well known renal manifestation of Sjogren's syndrome. But this type of transient proximal tubular dysfunction with distal tubular acidosis in Sjogren's syndrome is very rare and hypokalaemic tetany also deserves mention.
Assuntos
Hipopotassemia/etiologia , Quadriplegia/etiologia , Síndrome de Sjogren/complicações , Tetania/etiologia , Acidose Tubular Renal/etiologia , Adulto , Cálcio/sangue , Feminino , Humanos , Tetania/sangueRESUMO
The GRMD (Golden retriever muscular dystrophy) dog has been widely used in pre-clinical trials targeting DMD (Duchenne muscular dystrophy), using in many cases a concurrent immune-suppressive treatment. The aim of this study is to assess if such a treatment could have an effect on the disease course of these animals. Seven GRMD dogs were treated with an association of cyclosporine A (immunosuppressive dosage) and prednisolone (2 mg/kg/d) during 7 months, from 2 to 9 months of age. A multi-parametric evaluation was performed during this period which allowed us to demonstrate that this treatment had several significant effects on the disease progression. The gait quality as assessed by 3D-accelerometry was dramatically improved. This was consistent with the evolution of other parameters towards a significant improvement, such as the clinical motor score, the post-tetanic relaxation and the serum CK levels. In contrast the isometric force measurement as well as the histological evaluation argued in favor of a more severe disease progression. In view of the disease modifying effects which have been observed in this study it should be concluded that immunosuppressive treatments should be used with caution when carrying out pre-clinical studies in this canine model of DMD. They also highlight the importance of using a large range of multi-parametric evaluation tools to reliably draw any conclusion from trials involving dystrophin-deficient dogs, which reproduce the complexity of the human disease.
Assuntos
Imunossupressores/uso terapêutico , Distrofia Muscular Animal/tratamento farmacológico , Distrofia Muscular de Duchenne/tratamento farmacológico , Acelerometria , Animais , Fenômenos Biomecânicos/efeitos dos fármacos , Creatina Quinase/sangue , Ciclosporina/farmacologia , Ciclosporina/uso terapêutico , Modelos Animais de Doenças , Cães , Seguimentos , Marcha/efeitos dos fármacos , Humanos , Imunossupressores/farmacologia , Atividade Motora/efeitos dos fármacos , Distrofia Muscular Animal/sangue , Distrofia Muscular Animal/complicações , Distrofia Muscular Animal/fisiopatologia , Distrofia Muscular de Duchenne/sangue , Distrofia Muscular de Duchenne/complicações , Distrofia Muscular de Duchenne/fisiopatologia , Análise de Componente Principal , Tetania/sangue , Tetania/complicações , Tetania/fisiopatologiaRESUMO
Plasmodium falciparum is a malarial infection with high morbidity and wide spectrum of atypical presentation. Here we report an unusual presentation of malaria as tetany with alteration in calcium,phosphate and magnesium metabolism Hypocalcaemia in malaria can cause prolonged Q-Tc interval which could be arisk factor for quinine cardiotoxicity and sudden death Hence monitoring of serum calcium in severe malarial infection and cautious use of quinine in such patients is very important in management
Assuntos
Gluconato de Cálcio/administração & dosagem , Hipocalcemia/diagnóstico , Malária Falciparum/diagnóstico , Tetania/diagnóstico , Administração Intravenosa , Adulto , Antimaláricos/administração & dosagem , Artemisininas/administração & dosagem , Artesunato , Cálcio/sangue , Humanos , Hipocalcemia/sangue , Hipocalcemia/tratamento farmacológico , Magnésio/sangue , Malária Falciparum/sangue , Malária Falciparum/tratamento farmacológico , Malária Falciparum/parasitologia , Masculino , Fosfatos/sangue , Plasmodium falciparum/isolamento & purificação , Tetania/sangue , Tetania/etiologia , Resultado do TratamentoAssuntos
Cálcio/sangue , Rejeição de Enxerto/tratamento farmacológico , Transplante de Rim , Magnésio/sangue , Tacrolimo/efeitos adversos , Tetania/induzido quimicamente , Rejeição de Enxerto/sangue , Humanos , Imunossupressores/administração & dosagem , Imunossupressores/efeitos adversos , Masculino , Pessoa de Meia-Idade , Tacrolimo/administração & dosagem , Tetania/sangue , Tetania/diagnósticoRESUMO
Calcium tetany is a poorly defined disease of broiler breeder hens that results from acute hypocalcemia. It is characterized by impaired mobility, increased mortality, and absence of gross lesions that would explain the impaired mobility. To evaluate if hens with impaired mobility had calcium tetany or other abnormalities, blood values from normal and affected hens were determined using the i-STAT handheld clinical analyzer. Three flocks were evaluated weekly prior to peak production (range 25-30 wk of age) comparing normal hens to hens with clinically apparent calcium tetany. Calcium tetany suspect (CaTS) hens from four additional flocks were also evaluated. Significant hypocalcemia (P < 0.001) was observed in CaTS hens (average = 1.14 mmol/L ionized calcium [iCa]) compared to normal hens (average = 1.53 mmol/L iCa) in only one of three flocks sampled weekly. Clinically affected hens from one of the other four flocks also had hypocalcemia. Blood value abnormalities in mobility-impaired hens without hypocalcemia included hypernatremia. Findings in this study indicate calcium tetany is one cause of impaired mobility in breeder hens, but mobility impairment without hypocalcemia can also occur. Calcium tetany should be confirmed by finding significantly decreased levels of iCa in the blood, as diagnosis based on clinical presentation and necropsy results can be inaccurate. The i-STAT handheld clinical analyzer is an efficient, relatively low-cost method to determine iCa and other blood chemistry values that may be associated with impaired mobility in broiler breeder hens.
Assuntos
Cálcio/deficiência , Hipocalcemia/veterinária , Doenças das Aves Domésticas/diagnóstico , Tetania/veterinária , Animais , Análise Química do Sangue/instrumentação , Análise Química do Sangue/veterinária , Gasometria/instrumentação , Gasometria/veterinária , Galinhas , Feminino , Hipocalcemia/sangue , Hipocalcemia/diagnóstico , Hipocalcemia/patologia , Movimento , Doenças das Aves Domésticas/sangue , Doenças das Aves Domésticas/patologia , Valores de Referência , Tetania/sangue , Tetania/diagnóstico , Tetania/patologiaRESUMO
An 8-year-old girl presented with cramp and tingling of the hands due to hypocalcaemia caused by pseudohypoparathyroidism.
Assuntos
Cálcio/sangue , Cálcio/uso terapêutico , Hipocalcemia/etiologia , Pseudo-Hipoparatireoidismo/complicações , Pseudo-Hipoparatireoidismo/diagnóstico , Tetania/etiologia , Criança , Feminino , Mãos/patologia , Humanos , Hipocalcemia/sangue , Hipocalcemia/tratamento farmacológico , Pseudo-Hipoparatireoidismo/sangue , Pseudo-Hipoparatireoidismo/tratamento farmacológico , Tetania/sangue , Tetania/tratamento farmacológicoAssuntos
Encefalopatias Metabólicas/diagnóstico , Calcinose/diagnóstico , Doenças do Nervo Facial/diagnóstico , Hipocalcemia/complicações , Hipoparatireoidismo/complicações , Reflexo Anormal/fisiologia , Adolescente , Doenças dos Gânglios da Base/etiologia , Doenças dos Gânglios da Base/patologia , Doenças dos Gânglios da Base/fisiopatologia , Encéfalo/metabolismo , Encéfalo/patologia , Encéfalo/fisiopatologia , Encefalopatias Metabólicas/etiologia , Encefalopatias Metabólicas/patologia , Calcinose/etiologia , Calcinose/patologia , Educação Médica Continuada , Músculos Faciais/inervação , Músculos Faciais/fisiopatologia , Doenças do Nervo Facial/etiologia , Doenças do Nervo Facial/fisiopatologia , Feminino , Humanos , Hipocalcemia/sangue , Hipocalcemia/fisiopatologia , Hipoparatireoidismo/sangue , Síndrome , Tetania/sangue , Tetania/etiologia , Tetania/fisiopatologia , Tomografia Computadorizada por Raios XRESUMO
PURPOSE: To find out if the whole parathyroid hormone (wPTH) assay has practical advantages over the intact (iPTH) assay in patients with Graves' disease. METHODS: We measured iPTH and wPTH levels before and after subtotal thyroidectomy in 111 consecutive patients (94 women and 17 men) with Graves' disease. Blood samples for assays were obtained after the induction of anesthesia (basal) and following skin closure (postoperative). RESULTS: There was a significant correlation between wPTH and iPTH in both the basal and postoperative levels. Logistic regression analyses examining the relationship between the reduction in parathyroid hormone (PTH) levels and the incidence of tetany revealed that both the wPTH and iPTH assays were significantly equally predictive of postoperative tetany. CONCLUSION: We found that both the wPTH and iPTH assays were useful for predicting postoperative tetany in patients with Graves' disease, yielding similar results.
Assuntos
Doença de Graves/sangue , Doença de Graves/cirurgia , Hormônio Paratireóideo/sangue , Tetania/sangue , Tireoidectomia/efeitos adversos , Adolescente , Adulto , Criança , Feminino , Humanos , Período Intraoperatório , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/sangue , Curva ROC , Sensibilidade e EspecificidadeRESUMO
A 57-year-old woman who complained of exertional dyspnea was diagnosed as having severe aortic valve stenosis and mitral valve regurgitation. The patient underwent double valve replacement with a mechanical prosthesis. Postoperative laboratory data showed unusually high serum lactate dehydrogenase (LDH) levels, even though no perivalvular leakage was detected by echocardiography. Tetany occurred suddenly owing to hypoparathyroidism, which seemed to be a late complication after thyroidectomy. After calcium administration, the symptoms dramatically diminished, as did the serum LDH levels. Hypoparathyroidism should be doubted if serum LDH levels increase higher than the normal range following valve replacement without obvious perivalvular leakage.
Assuntos
Implante de Prótese de Valva Cardíaca , L-Lactato Desidrogenase/sangue , Tetania/enzimologia , Tetania/etiologia , Tireoidectomia/efeitos adversos , Estenose da Valva Aórtica/cirurgia , Feminino , Humanos , Hipoparatireoidismo/complicações , Hipoparatireoidismo/enzimologia , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/cirurgia , Hormônio Paratireóideo/sangue , Valor Preditivo dos Testes , Tetania/sangue , Tireoidite/cirurgiaAssuntos
Tetania/etiologia , Deficiência de Vitamina D/complicações , Feminino , Humanos , Compostos de Magnésio/uso terapêutico , Deficiência de Magnésio/sangue , Deficiência de Magnésio/complicações , Deficiência de Magnésio/tratamento farmacológico , Pessoa de Meia-Idade , Tetania/sangue , Tetania/tratamento farmacológico , Resultado do Tratamento , Vitamina D/sangue , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/tratamento farmacológicoRESUMO
No disponible
Assuntos
Feminino , Pessoa de Meia-Idade , Humanos , Tetania/etiologia , Deficiência de Vitamina D/complicações , Compostos de Magnésio/uso terapêutico , Deficiência de Magnésio/sangue , Deficiência de Magnésio/complicações , Deficiência de Magnésio/tratamento farmacológico , Tetania/sangue , Tetania/tratamento farmacológico , Resultado do Tratamento , Vitamina D/sangue , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/tratamento farmacológicoRESUMO
We measured intraoperative parathyroid hormone (IOPTH) levels before and after thyroidectomy in a large group of patients to test whether changes in IOPTH can predict postoperative tetany. Subjects were 111 consecutive patients (94 females and 17 males) with Graves' disease undergoing subtotal thyroidectomy. Blood samples for IOPTH assay were obtained after anesthesia (basal) and following skin closure (postoperative). Data were compared between patients who developed tetany (n = 9) and those who did not (n = 102). There was no significant difference in sex, age, period of antithyroid drug administration, or the weight of the thyroid between the two groups. The preoperative serum calcium level was significantly lower (p < 0.05) and the basal IOPTH significantly higher (p < 0.05) in the tetany group than in the non-tetany group. The IOPTH level was significantly lower (p < 0.005) and the average percent decrease in IOPTH levels was higher (p < 0.001) in the tetany group than in the non-tetany group. A decrease in IOPTH of more than 70% was shown to be 78% sensitive, 94% specific, and 93% accurate, and it has 78% positive predictive value and 94% negative predictive value for the development of tetany. Our study shows that a postoperative decrease of IOPTH level is the most predictive of postoperative tetany of the clinical risk factors investigated. We recommend IOPTH measurement as an adjunct to postoperative management of patients with Graves' disease to assist in preventing hypocalcemia and determining the earliest time for safe discharge.
Assuntos
Doença de Graves/cirurgia , Hormônio Paratireóideo/sangue , Tetania/etiologia , Tireoidectomia/efeitos adversos , Adolescente , Adulto , Idoso , Criança , Feminino , Humanos , Imunoensaio , Período Intraoperatório , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Tetania/sangueRESUMO
BACKGROUND: Symptomatic hypocalcemia remains the main postoperative complication after total thyroidectomy. The aim of the present study was to evaluate the role of oral supplementation of calcitriol and calcium salts in preventing severe postoperative hypocalcemia after total thyroidectomy. METHODS: A consecutive series of patients undergoing total thyroidectomy followed by administration of 500 mg of calcium salts 3 times per day were randomized to 3 different postoperative medical treatments: in group A, .5 microg of calcitriol twice per day was administered to 104 patients; in group B, 1 mmicrog of calcitriol twice per day was administered to 111 patients; and in group C, 202 patients did not receive calcitriol. RESULTS: The rate of postoperative tetany in group A was 2.9%, in group B was 0%, and in group C was 7.4% (P=.03) and the rate of paresthesias was 28.8%, 17.1%, and 22.3%, respectively (P=.19). At discontinuation of calcitriol/calcium salts treatment, intact parathyroid hormone levels did not significantly differ from the preoperative levels. Receiver operating characteristic (ROC) curve analysis showed that the area under the curve for serum concentration of calcium in predicting postoperative tetany was .749, .858 and .862 on the first, second, and third postoperative day, respectively. The best cut-off value of calcemia for prediction tetany was 7.5 mg/dL, and the rate of severe hypocalcemia on the third postoperative day was 23.1% in group A, 9.9% in group B, and 27.2% in group C (P=.001). CONCLUSIONS: Oral administration of 1 microg of calcitriol twice per day and 500 mg of calcium salts 3 times per day after total thyroidectomy significantly decreases the risk of severe postoperative hypocalcemia.
Assuntos
Calcitriol/administração & dosagem , Agonistas dos Canais de Cálcio/administração & dosagem , Hipocalcemia/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Tireoidectomia , Administração Oral , Adulto , Cálcio/sangue , Cálcio/uso terapêutico , Quimioterapia Combinada , Feminino , Humanos , Hipocalcemia/sangue , Hipocalcemia/epidemiologia , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Parestesia/sangue , Parestesia/epidemiologia , Parestesia/prevenção & controle , Cuidados Pós-Operatórios , Complicações Pós-Operatórias/epidemiologia , Curva ROC , Estatísticas não Paramétricas , Tetania/sangue , Tetania/epidemiologia , Tetania/prevenção & controleRESUMO
BACKGROUND: Postoperative tetany occurs in patients with secondary hyperparathyroidism caused by a deficiency in calcium and vitamin D concomitant with transient hypoparathyroidism induced by surgery. In the present study, we further clarified the risk factors by referring to serum 25-hydroxyvitamin D [25(OH)D] and alkaline phosphatase. STUDY DESIGN: The serum levels of intact parathyroid hormone, calcium and other electrolytes, and 25-hydroxyvitamin D [25(OH)D] were measured preoperatively in 178 female patients with Graves' disease who underwent subtotal thyroidectomy. RESULTS: Of the 178 female patients, 15 (8.4%) developed tetany. Univariate analysis of 16 possible risk factors showed that 2 were statistically significant: serum 25(OH)D and alkaline phosphatase levels. The incidence of tetany according to the serum levels of 25(OH)D and alkaline phosphatase was 19.1% (9/47) in patients with 25(OH)D < or = 25 nmol/L and alkaline phosphatase > 155, 11.8% (4/34) in those with 25(OH)D < or = 25 nmol/L and alkaline phosphatase < or = 155, 6.7% (2/30) in those with 25(OH)D > 25 nmol/L and alkaline phosphatase > 155, and 0% (0/50) in those with 25(OH)D > 25 nmol/L and alkaline phosphatase < or = 155. CONCLUSIONS: Patients with Graves' disease who have vitamin D deficiency with high serum alkaline phosphatase levels are the highest-risk group for postoperative tetany. Serum 25(OH)D and alkaline phosphatase should be monitored in patients with Graves' disease.