Tetany is a medical condition that leads to painful muscle contractions. It typically begins in the jaw and then progresses to the rest of the body.
Hence, to know its types, symptoms, causes, prevention, and treatment methods, read this article till the end.
What is Tetany?
Tetany is a medical condition consisting of the involuntary contraction of muscles that leads to painful muscle cramps, larynx, and sensory disturbances. It is caused by low blood calcium levels or electrolyte imbalance. High magnesium or calcium supplements can reduce the occurrence of Tetany.
It is a disorder with a highly variable clinical presentation. It includes enhanced neuromuscular activity and associated sensory disturbance. These spasms occur due to a sudden decrease in calcium levels in the blood, which is essential for proper muscle function. The condition can affect any muscle in the body, but it typically affects the hands, feet, and face.
Mild symptoms may include circumoral numbness, muscle cramps, or paresthesias of hands and feet. In severe cases, patients may present with laryngospasm, generalized muscle cramps, seizures, or even myocardial dysfunction. Trousseau sign and Chvostek sign are clinical tests to unmask latent Tetany.
The increased excitability of the peripheral nerves is due to either low serum calcium (true hypocalcemia denotes a decrease in the ionized calcium level even though the total serum calcium level may be expected) or alkalosis in which the proportion of the serum calcium in the ionized form is decreased.
Types of Tetany
Latent (spasmophilia): It is caused by intracellular magnesium deficiency and increased respiratory drive. The muscle spasms can be painful and affect the hands, feet, face, and neck. Other symptoms of latent Tetany may include numbness and tingling in the hands and feet, anxiety, and irritability.
Manifest Tetany: Manifest Tetany refers to a more severe form of Tetany in which the symptoms are more pronounced and may include muscle cramps, spasms, and contractions, as well as tremors, muscle weakness, and twitching. The symptoms include numbness around the mouth and prickling of the hands and feet.
Symptoms of Tetany
Some common mild symptoms of Tetany include:
- Numbness around the mouth
- Muscle cramps
- Paresthesia (burning sensation in the hands and feet)
- Shortness of breath
Some severe symptoms of Tetany include:
- Laryngospasms can cause difficulty breathing.
- Bronchospasms (when the muscles lining your lungs’ airways tighten).
- Painful muscle cramps.
- Loss of vision
- Tetany seizures
- A diminished cardiac function, such as an irregular heart rhythm (arrhythmia).
While Tetany is often not life-threatening, it can sometimes lead to rhabdomyolysis, a condition that causes muscle breakdown or death.
What Causes Tetany?
Tetany is typically brought on by an electrolyte imbalance, frequently many ones. When they dissolve in water, electrolyte chemicals acquire a natural positive or negative electrical charge.
Since your body comprises 60 percent water, electrolytes are present in almost all your body’s fluids and cells. They assist your body in some ways, including regulating chemical processes and preserving fluid equilibrium inside and outside your cells. Your muscles contract because your cells employ electrolytes to carry electrical charges.
The cause of Tetany often involves a combination of metabolic abnormalities rather than a single cause.
- Hypocalcemia: Tetany often results from low blood calcium levels, a common reason. A lack of calcium can cause uncontrollable muscle spasms since calcium is essential for muscle contraction. Vitamin D insufficiency, renal illness, hypoparathyroidism, and malabsorption syndromes are a few of the causes of hypocalcemia.
- Hypomagnesemia: It happens due to low magnesium levels in the blood. Magnesium is an important electrolyte that is a vital part of many body functions. Chronic disease, heavy alcohol intake, gastrointestinal issues, kidney issues, and other conditions can cause hypomagnesemia.
- Hypokalemia: It happens due to low potassium levels in your blood. Potassium is an electrolyte crucial for adequately functioning nerves, muscle cells, and the heart. Common causes of hypokalemia include diuretics, vomiting, diarrhea, and chronic kidney disease.
- Alkalosis: An increase in blood pH can also cause tetany. Alkalosis can occur due to several factors, including hyperventilation or ingestion of alkaline substances.
- Respiratory alkalosis/ Hyperventilation: this happens when you breathe too fast or deep, causing your lungs to get rid of too much carbon dioxide. It can decrease the carbon dioxide levels in the blood, which then becomes alkaline. Hyperventilation due to stress or anxiety can also lead to Tetany.
- Certain medications: Some medications, such as diuretics or phenytoin, can interfere with calcium levels in the body.
- Other conditions: Tetany can also occur due to other medical conditions, such as kidney disease, liver disease and vitamin D deficiency. Additionally, certain genetic disorders can cause tetanus, such as hyperekplexia or familial hypocalciuric hypercalcemia.
What is the Main Cause of Hypocalcemic Tetany?
The leading cause of hypocalcemic tetany is low calcium levels in the blood, also known as hypocalcemia. Calcium is crucial to muscle health and function as a necessary mineral, including the muscles’ capacity to contract and relax. Low blood calcium levels make the neurological system more excitable, which can result in tetany or uncontrollable muscle contractions or spasms.
In some cases, hypocalcemic tetany may be triggered by other factors, such as hyperventilation, which can cause respiratory alkalosis and decrease blood calcium levels. Hypocalcemia may result from several factors, including:
Vitamin D Deficiency
Vitamin D is essential for the absorption of calcium from the gut. Without adequate vitamin D levels, the body cannot absorb enough calcium to maintain normal levels in the blood. Vitamin D deficiency can occur due to insufficient sunlight exposure, poor dietary intake, or malabsorption syndromes. Hypocalcemia due to vitamin D deficiency is often seen in elderly patients, those with limited sun exposure, and those with a poor diet.
The kidneys critically regulate the body’s calcium balance. Low calcium levels might result from the kidneys’ inability to adequately remove extra phosphorus from the body when they are not working correctly. The kidneys also aid in activating vitamin D, which is compulsory for calcium absorption. Therefore, any kidney impairment can result in hypocalcemia.
The parathyroid hormone (PTH), made by the parathyroid glands, controls the body’s calcium levels. Hypocalcemia may result from insufficient PTH production by the parathyroid glands if they are not operating correctly or have undergone surgical removal. Hypoparathyroidism is the name given to this condition.
Some medical conditions can affect the body’s ability to absorb calcium from the gut, leading to hypocalcemia. These conditions may include celiac disease, inflammatory bowel disease, and certain surgeries, such as gastric bypass surgery.
Certain medications can interfere with calcium absorption or utilization, leading to hypocalcemia. Diuretics can cause increased excretion of calcium in the urine, while anticonvulsants and some cancer treatments can interfere with vitamin D activation.
Other medical conditions can also cause hypocalcemia. For example, acute pancreatitis can lead to hypocalcemia due to calcium binding with fatty acids in the bloodstream. Chronic alcoholism can also cause hypocalcemia due to decreased calcium absorption and increased urinary excretion. Magnesium deficiency can also lead to hypocalcemia as magnesium is required for the release of PTH, which, in turn, regulates calcium levels
Who is Most Likely to Get Tetany?
Tetany can occur in individuals of any age, gender, or race. However, specific populations may be more susceptible to tetany than others due to various risk factors.
- People with medical conditions affecting calcium metabolism, such as chronic kidney disease, hypoparathyroidism, or malabsorption syndromes, are at higher risk of tetany due to hypocalcemia.
- Individuals who have undergone thyroid or parathyroid surgery may also be at risk of developing tetany, as the surgery can affect calcium regulation in the body.
- Individuals with a history of malnutrition or following a restrictive diet that lacks essential nutrients, including calcium and magnesium, may also be at risk of developing tetany due to nutritional deficiencies.
- People undergoing treatments that affect calcium levels, such as chemotherapy or radiation therapy, may risk developing hypocalcemia and tetany.
- People who experience hyperventilation due to anxiety or panic attacks may also be at risk of developing tetany due to respiratory alkalosis, which can cause a decrease in blood calcium levels.
Diagnosis of Tetany
The diagnosis of tetany typically involves a combination of clinical evaluation, medical history assessment, and laboratory tests. Here’s an overview of the diagnostic process for tetany:
Medical History and Physical Examination
A detailed history, including any symptoms you have been experiencing. A physical examination to assess muscle strength, reflexes (Chvostek and Trousseau signs), and any visible signs of muscle spasms or cramps.
Laboratory tests are crucial in diagnosing tetany. Blood samples will be taken to measure various parameters, including calcium, magnesium, phosphate, and parathyroid hormone (PTH) levels. Low calcium levels are a crucial feature of tetany. The total calcium level may be measured, but the ionized calcium level is a more accurate reflection of calcium status in the body.
An ECG may be performed to assess the heart’s electrical activity. Low calcium levels can affect heart function and may result in abnormal ECG findings.
It is collected to measure calcium and other electrolyte levels. This helps determine whether there is excessive calcium loss through the urine, which can contribute to hypocalcemia.
In some cases, further tests may be required to identify the underlying cause of tetany. These tests may include thyroid function tests, renal function tests, or genetic testing to assess for conditions such as hypoparathyroidism or other disorders affecting calcium metabolism.
How is Tetany Treated?
The treatment of tetany depends on the underlying cause of the condition.
If low blood calcium levels result in tetany, treatment options include vitamin D supplementation and calcium. Patients can take calcium supplements orally, whereas vitamin D supplements can be given as ergocalciferol or cholecalciferol. In cases of severe hypocalcemia, intravenous calcium may be necessary. In addition to accessories, the underlying cause of hypocalcemia should be treated. For instance, controlling renal illness may be required if it is the underlying cause of hypocalcemia to assist in normalizing calcium levels.
If low magnesium levels in the blood cause tetany, treatment may involve magnesium supplementation. Patients can take magnesium supplements orally or intravenously in severe cases. If malabsorption syndromes cause hypomagnesemia, treatment may include addressing the underlying condition causing malabsorption.
Tetany brought on by hyperventilation may be treated with breathing exercises or relaxation methods to calm the patient and avoid rapid breathing. Slow, deep, pursed-lip breathing and belly breathing are other helpful techniques. Counseling or therapy may also aid in stress management and stop excessive breathing.
If hypoparathyroidism is the cause of tetany, treatment may involve hormone replacement therapy with calcium and vitamin D supplements. The goal of treatment is to maintain normal calcium levels in the blood. Regular monitoring of calcium levels and adjustment of medication dosages may be necessary.
If alkalosis causes tetany, treatment may involve correcting the pH of the blood by addressing the underlying cause. For example, if the alkalosis is caused by hyperventilation, treatment may include managing rapid breathing to prevent further alkalosis. Medications that help restore normal pH levels may sometimes be necessary.
If another medical condition causes tetany, treatment may involve addressing the underlying condition. For example, if the tetany is caused by kidney disease, treatment may include managing the kidney disease to help normalize calcium and magnesium levels. If genetic disorders cause tetany, treatment may involve genetic counseling and management of symptoms.
Prevention of Tetany
Depending on the various reasons, the following steps can help prevent tetany:
Tetany brought on by mineral deficiencies can be avoided with a balanced diet that includes foods high in calcium, magnesium, and other necessary elements. Tetany can be avoided by consuming fruits, vegetables, complete grains, lean meats, and healthy fats.
Tetany brought on by nutritional deficits can be avoided by taking calcium and magnesium supplements. However, a healthcare practitioner should be consulted before taking any supplements, as consuming too many of these minerals can be dangerous.
Spending time in the sun can help the body produce vitamin D, which is essential for calcium absorption and can help prevent the development of tetany caused by hypocalcemia.
Managing Underlying Medical Conditions
Managing underlying medical conditions such as kidney disease, hypoparathyroidism, or malabsorption syndromes can help prevent the development of tetany.
Managing Stress and Anxiety
Hyperventilation brought on by stress and anxiety can result in alkalosis and tetany. Deep breathing, meditation, and yoga are all relaxing practices that can reduce stress and stop the onset of tetany.
Avoiding Alkaline Substances
Avoid ingesting alkaline substances such as antacids can help prevent the development of alkalosis and tetany.
Complications Caused by Tetany
Because Tetany can be due to a severe condition, not seeking treatment can lead to serious complications and permanent damage.
Once your healthcare provider has identified the underlying cause, you need to follow the treatment plan your healthcare provider explicitly designed to reduce the risk of potential complications. Such complications may include the following:
- Respiratory distress: Tetany can cause respiratory distress, as muscle spasms and contractions can interfere with normal breathing.
- Cardiac arrhythmias: Low calcium levels in the blood can lead to heart rhythm disturbances, which can be severe and life-threatening.
- Seizures: Tetany can cause seizures, which are sudden, uncontrolled electrical discharges in the brain.
- Coma: In severe cases, Tetany can cause unconsciousness, leading to coma.
- Pneumonia: Tetany can cause swallowing difficulties, increasing the risk of pneumonia and other respiratory infections.
- Bone fractures: Tetany can cause weakness and muscle wasting, increasing the risk of fractures and other orthopedic problems.
When to Consult a Doctor?
Ignoring that tetany is a serious complication and may lead to other medical complications is an injustice to your health. It is recommended to consult a doctor as soon as possible to get the disease treated.
FAQs About Tetany Answered By Your Doctor Online Team
Severe Tetany can cause painful muscle cramps and spasms of the larynx. It can also cause difficulty with breathing.
Tetany can be cured. Severe cases require immediate medical attention. It typically involves IV calcium replacement and other therapies. Not seeking medical treatment can cause permanent damage.
Tetany and seizures are two different conditions. A seizure is an uncontrolled burst of electrical activity in your brain that can cause behavioural and movement changes. In comparison, Tetany involves involuntary muscle contractions.
Calcium or magnesium supplements may be given orally or intravenously to treat tetany caused by low blood levels of these minerals. In severe cases, intravenous calcium gluconate may be provided to increase blood calcium levels rapidly. Other medications may also be used to treat tetany depending on the underlying cause, such as hormone replacement therapy in hypoparathyroidism or acid-base balancing medications in cases of alkalosis.
Patients may receive calcium or magnesium supplements intravenously or orally to alleviate tetany from low blood levels of these minerals. In extreme circumstances, intravenous calcium gluconate may quickly raise blood calcium levels. Depending on the underlying reason, other medications may also be used to treat tetany, such as hormone replacement therapy in hypoparathyroidism or medications to balance acid-base in situations of alkalosis.