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tetanie (nejen) pro Dr. Minařík

Dobrý den. Jaj jste odepisoval Mii s tim Neurolem, tak posílám nějaká abstrokta o základních přístupech v léčbě tetanie. Často je to problém, který je doprovázen (nebo se vzájemně potencují) s panickou poruchou (hyperventilace jako falešně pozitivní reakce na domělé snížení CO2), hyperventilací různé etiologie - např různé acidozy, fibromialgie, a různé neurozy. české zdroje např. neurologiepropraxi.cz. [Symptoms and management of tetany][Article in Japanese] Ito N, Fukumoto S. The University of Tokyo Hospital, Department of Internal Medicine, Division of Nephrology and Endocrinology, Japan. Tetany is a series of symptoms characterized by painful muscle cramp that derives from enhanced neuromuscular excitability due to hypocalcemia, hypomagnesemia or alkalosis. In a broad sense, tetany includes associated sensory disturbance. Typical symptoms of tetany include carpopedal spasm, laryngospasm and generalized seizure. Chvostek and Trousseau signs are provocative tests for diagnosis of latent tetany. Many diseases including endocrine disorders like hypoparathyroidism and alkalosis by hyperventilation can cause tetany. Infusion of calcium or magnesium is effective as an acute therapy for tetany. However, subsequent diagnosis and treatment of underlining diseases are mandatory. PMID: 17660621 [PubMed - indexed for MEDLINE] [Tetany as a difficult diagnostic problem in the neurological outpatient department][Article in Polish] Toruńska K. Kliniki Neurologii CSK MSWiA w Warszawie. The paper presents a model of diagnostic and therapeutic management of tetany, with special attention paid the role of magnesium and to psychotherapy or psychiatric treatment. Two types of tetany are distinguished: manifest and latent (spasmophilia). The former, due to hypocalcemia, is relatively rare and usually postoperative (parathyroid tetany), while the mechanism of the much more common latent tetany or spasmophilia involves hyperventilation and magnesium deficiency. Latent tetany affects particularly young women. There are many signs of spasmophilia, but none is specific, so this pathology is difficult to diagnose. PMID: 14593759 [PubMed - indexed for MEDLINE] [Latent tetany masked by syndroms of bronchial asthma and depressive syndrome. Case report][Article in Polish] Wajda B, Drozdowska A, Kuziemski K, Górska L, Lewandowska K, Jassem E. Klinika Alergologii AM, Gdańsku. Tetany, which occurs in young women, poses common diagnostic problem. Two types of tetany are distinguished: one which is characterized by hypocalcemia and which rarely occurs (in person after strumectomy in the course of post-operational hypoparathyroidism) and latent one, which occurs more often. In the literature there is a lack of precise data concerned witch most probably results from its underestimation. Clinical symptoms which appear in latent tetany (normocalcemic) are related to the intracellular magnesium deficiency and increased respiratory drive. A noncharacteristic clinical picture and the lack of a pathognomonic symptom, cause that despite of the fearly common occurrence, the latent tetany is rarely recognized. In this paper the case of a 53 year old women has been described. The women had the symptoms of gastroesophageal reflux of asthma and depressive syndrome, witch masked the symptoms of the latent tetany. PMID: 17269373 [PubMed - indexed for MEDLINE] [Tetany][Article in German] Gärtner R. Medizinische Klinik Innenstadt, Universität München. rgartner@medinn.med.uni-muenchen.de The hallmark of acute hypocalcemia (ionized calcium <0.75 mmol/l) is tetany, which is characterized by neuromuscular irritability. The symptoms may be mild with circumoral numbness, paresthesias of hands and feet, and muscular cramps or severe with laryngospasm, focal or generalized tonic muscle cramps, or seizures. Myocardial dysfunction and prolongation of QT interval also may occur. Most often, acute hypocalcemia occurs after thyroid or parathyroid surgery. Rarer cases are intravascular binding of ionized calcium by phosphate, citrate, or drugs such as foscarnet or bisphosphonates. The most appropriate treatment is intravenous calcium, in the form of 100-200 mg of elemental calcium. Thereafter, the therapy depends on the underlying disease. In most cases vitamin D has to be added to calcium substitution. In cases of hypomagnesemia, magnesium and not calcium has to be substituted. It has not yet been proven in clinical trials whether substitution of magnesium and/or calcium influences the clinical outcome in patients with severe sepsis or pancreatitis who show both hypomagnesemia and hypocalcemia. PMID: 14689085 [PubMed - indexed for MEDLINE]

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