With a disorder of calcium-phosphorus metabolism, which accompanies moderate or severe rickets, 4% of children develop spasmophilia, which is also called infantile tetany. This pathology is accompanied by a spastic state of the muscles of the limbs, face, larynx, as well as the occurrence of general clonic and tonic convulsions. It is usually detected between the ages of three months and two years. One of the most striking manifestations of the developing disease are the symptoms of Chvostek, Trousseau and Lyust, which help to determine the severity of the ongoing disease. We will talk about how these symptoms are determined and how they are treated later in the article.
How are spasmophilic symptoms checked?
To check for the presence of Chvostek's symptom, also called the phenomenon facial nerve, the child is placed on a bed without a pillow. The legs should be straightened and the arms should lie along the body.
The symptom is checked by lightly tapping with a percussion hammer or fingers at the exit site trigeminal nerve(above the zygomatic arch). If the patient experiences involuntary twitching of the eyelid and corner upper lip, then the mentioned symptom is considered positive. By the way, it is checked on both cheekbones.
Chvostek's symptoms have 3 degrees of manifestation:
- Muscle contraction throughout the area of innervation of the facial nerve.
- Contraction of the muscles in the corner of the mouth and at the wing of the nose.
- Muscle contraction only in the corner of the mouth.
In the presence of obvious tetany, the child exhibits the first degree of symptom even from a light touch in the area of the facial nerve.
Additional ways to check for antispasmodic symptoms
No less indicative in terms of determining the severity of the baby’s condition are the symptoms of Trousseau and Lust.
- Trousseau's sign is detected by compression of the middle of the child's shoulder. In this case, the doctor should try to capture as much of the soft tissue of his hand as possible. If, as a result of this (about 2-3 minutes after compression), the patient’s fingers take a forced position, called “obstetrician’s hands” (that is, the thumb is brought to the palm, the index and middle fingers are extended, and the ring and little fingers are bent), then the symptom is considered positive. To check for its presence in older children or adults, you can use a blood pressure cuff, pumping air into it until the pulse stops.
- The Lust sign is checked using a hammer, which is tapped behind the head of the minor or by squeezing the gastrocnemius muscle in the area of the Achilles tendon. If the patient experiences involuntary abduction of the foot (“ballerina’s foot”), then the symptom can be considered positive. It is tested on both limbs.
The symptoms of Chvostek, Trousseau, and Lyust are considered spasmophilic. They become positive if a sick child has a change in the amount of calcium in the blood that is responsible for muscle contractions. This can be caused not only by the presence of rickets, but also by other diseases.
What is tetany
Chvostek's and Trousseau's symptoms are signs of spasmophilia (tetany). This disease is characterized by increased nervous excitability, manifested in the limbs or larynx. More often this pathology observed in boys in the first six months of life.
And the biological basis of this disease is low level ionized calcium in the child's blood.
Why is Chvostek's sign dangerous in children?
Photos of children with tetany allow us to understand what the signs of the disease are. The main one is laryngospasm, which is expressed by difficulty breathing, pale face, sweating, and sometimes loss of consciousness. Periodic cramps of the feet and hands (carpopedal spasm), sometimes lasting several hours, are also characteristic. Spasms of other muscle groups are also possible - respiratory, chewing, eye, etc.
But most severe sign The disease is considered to be an attack of eclampsia - clonic-tonic convulsions, starting from the face and turning into cramps of the limbs and laryngospasm. In this case, the child most often loses consciousness, foam appears on the lips, and involuntary urination. Eclampsia is dangerous due to the possibility of respiratory or cardiac arrest.
Who might get tetany?
In the first days of life convulsive states and hypocalcemia most often occur in babies born prematurely, in twins, as well as in those who have had jaundice or an infectious disease.
Chvostek's symptom in children in the first months of life can be provoked by both a decrease in the intake of calcium into the child's body and an increase in the secretion of calcitonin. This condition Doctors also associate it with a disruption in the supply of phosphorus and calcium when the baby is suddenly switched to feeding with cow's milk, as well as (in rare cases) with a lack of vitamin D and calcium in the mother's body.
As a rule, in children, hypocalcemia is manifested by neuromuscular irritability, convulsions, vomiting, tachycardia and respiratory symptoms.
Treatment of tetany
Attacks of eclampsia require urgent assistance to the child, and in case of respiratory or cardiac arrest, resuscitation measures.
For any manifestations of tetany, the child is prescribed anticonvulsants (“Sibazon” intramuscularly or intravenously, “Sodium oxybarbutyrate” intramuscularly, “Phenobarbital” rectally in suppositories or orally, etc.). Intravenous administration of 10% calcium gluconate solution or intramuscular 25% magnesium sulfate solution is also indicated.
Spasmophilia, which causes Chvostek's and Trousseau's symptoms, usually has a favorable prognosis in most cases. The only danger is prolonged laryngospasm, which threatens respiratory arrest.
When the child reaches the age of 2-3 years pathological condition eliminated as a result of stabilization of calcium and phosphorus levels in the blood.
Hypoparathyroidism is a disease that is accompanied by Chvostek's symptom
This is also a clear sign a pathological condition called hypoparathyroidism, in which there is a decrease in function. Most often, this problem occurs as a result of surgery for the disease thyroid gland or if it contains inflammatory process. And sometimes dysfunction can be caused by infectious processes, such as measles or influenza.
In newborns, hypoparathyroidism develops in the case of a congenital absence of the parathyroid glands or when their functioning is suppressed by increased release of parathyroid hormone in the mother's body during pregnancy.
In this case, the patient, as a rule, exhibits a decrease in the calcium content in the blood in parallel with an increase in the concentration of phosphorus. And outwardly this is manifested by the already described tetany, intestinal phenomena, abnormalities in the growth of teeth, nails and hair, as well as skin changes.
In such cases, the symptoms of Chvostek and Trousseau, along with laboratory tests, help to accurately identify the developed tetanic condition and diagnose the patient.
Treatment of hypoparathyroidism
To treat this disease, it is important to take into account the reasons that caused its appearance, as well as the severity of the symptoms. At acute course illness with symptoms of tetany, urgent administration of 10% calcium chloride or calcium gluconate intravenously is recommended. This is done slowly, taking into account the fact that the first mentioned solution contains 27% of the substance of the same name, and the second contains only 9%.
As a rule, in order to eliminate Chvostek's symptoms, treatment with calcium supplements is required for at least 10 days. Good effect provides calcium intake orally, and doctors advise doing this by dissolving the drug in milk to prevent the development of gastritis.
The chronic condition of hypoparathyroidism requires taking vitamin D, starting with a loading dose (200-300 thousand units per day), with mandatory monitoring of phosphorus and calcium levels in the blood, and after normalizing their levels, the dose is reduced to 50 thousand units. per day in children under one year old or up to 125 thousand units. - in patients after a year.
What other diseases cause Trousseau and Chvostek symptoms?
In addition to diseases caused only by a decrease in calcium in the blood plasma for any reason, the symptoms of Chvostek, Trousseau and Lust can also be found in other ailments. These include:
- Neurasthenia with an anxious and suspicious state, manifested in the form of The patient experiences periodic disturbances in the rhythm of breathing, simulating suffocation, with a feeling of a lump in the throat, lack of air, and sometimes with loss of consciousness and convulsions.
- Dyscirculatory processes combined with asthenic or astheno-neurotic syndrome, characterized by a state of constant fatigue and nervous exhaustion, as well as headaches, sleep disturbances and dizziness.
- Hysteria, epilepsy and other diseases.
Prevention of calcium imbalance in a child
As you have probably already seen, for diseases that accompany Chvostek’s symptom in children, treatment comes down to the inevitable restoration of blood levels normal level calcium and phosphorus. Therefore, the prevention of these pathologies also requires, first of all, monitoring the concentration of the mentioned substances, which is carried out by local pediatricians.
It is important to create optimal conditions for fetal development in a pregnant woman. To do this, if the expectant mother lives in unsatisfactory social and living conditions or belongs to a risk group (if diabetes mellitus, nephropathy, hypertension and rheumatism), she is prescribed vitamin D in the last 2 months of pregnancy. In a normal pregnancy, following a diet and physical activity is sufficient.
And for a newborn to grow strong and healthy, it is important to have breastfeeding, timely introduction of complementary foods, daily stay on fresh air, free swaddling, massage, gymnastics and light-air baths.
Trousseau) - 1) (syn. Trousseau phenomenon) - a tonic spasm of the hand that occurs in response to pressure in the area of the neurovascular bundle on the shoulder; a sign of spasmophilia or tetany; 2) development of acute thrombophlebitis of large veins in cancer internal organs.
“Obstetrician’s hands”? This is when fingers 1, 4, 5 are bent and you cannot move them normally. When the nerves of the hand are damaged.
or carpal tunnel syndrome. What is it?
This is completely called the Wernicke-Mann pose. Occurs with hemiparesis (paresis of one half of the body), characteristic of damage to the central motor neuron.
Trousseau syndrome
This syndrome is named after the person who first established the relationship between the combination of thrombophlebitis and cancer of internal organs - the French doctor Andre Trousseau. They call him by his name typical symptom for spasmophilia - “the hand of the obstetrician.” Trousseau syndrome refers to paraneoplastic processes, and links together spontaneous migratory thrombophlebitis and advanced cancer of the esophagus or other internal organs (usually the stomach, liver).
Paraneoplastic processes are processes occurring in the body of elderly and old people (they are much less common in young people), which develop when oncological diseases, but are in no way connected directly with the tumor itself - that is, neither with its metastases, nor with its growth. Such nonspecific reactions occur in response to those changes that arise due to the presence of an altered, neoplastic, essentially foreign process for the body.
Causes
There are several causes of Trousseau syndrome. One of them lies in the excessive formation of thrombus-forming factors. Almost any tumor, starting from a small size, produces fibrinopeptide A, which, when detected, can be a marker of a tumor of internal organs - this is due to the fact that the quantitative indicators of fibrinopeptide A and the size of the tumor are associated with a fairly high degree of accuracy.
The second reason is a change in hemostasis in cancer patients according to the type external mechanism coagulation - that is, after substances that are not part of its composition enter the blood (in in this case tumor cells). Tumors are a constant source of tissue thromboplastin, as well as a special “cancer procoagulant” that converts coagulation factors VII and X into serine proteinase.
More often this symptom appears with tumors of the gastrointestinal tract.
Symptoms
As is often the case in medicine, the discovery of this syndrome is associated with the death of the author himself. Andre Trousseau had been studying neoplastic pathology for a long time, and had already noticed signs of spontaneous thrombosis. Since the relationship between thrombosis and tumors was obvious to Trousseau, he assumed that he himself had stomach cancer, especially since there were not too obvious, but nevertheless alarming symptoms. And so it turned out - Andre died of stomach cancer.
Tumors of internal organs do not always make themselves felt with typical symptoms. And people often tend to reduce the significance of what they consider to be terrible complaints and symptoms. The tumor grows, its external influence on the body increases, and pareneoplastic processes are provoked. If phlebothromboses form in different places, are difficult to treat, or even not treatable at all, if there are thromboses of large arteries not associated with any diseases known to the patient, a cancerous tumor should be assumed.
Diagnosis and treatment
Diagnosis must be thorough. Increased thrombotic processes, constant changes in blood parameters, indicating changes in coagulation factors. It is necessary to conduct a blood test for the presence of fibrinopeptide A and other coagulation factors, and also pay attention to all nonspecific complaints that the patient has. A thorough diagnosis will also be required to determine the location of the tumor.
There is no specific treatment for Trousseau's syndrome (as well as other paraneoplastic processes). They can only weaken clinically or regress with successful treatment(even palliative).
Forecast
Entirely depends on the prognosis of the tumor and the possibilities of its radical treatment.
7 reasons why you can't quit smoking.
Convulsive syndrome
In this article we will talk about cramps. First of all, about what pathological conditions they are typical for.
Cramps themselves are not a disease, but a symptom, and therefore they are not treated. What do they do with them, you ask? The answer is: they stop it, or, in simple terms, remove it.
What should you do if a child has seizures? First of all, call an ambulance. Doctors will administer anticonvulsants and take the child to the hospital or leave him at home under the supervision of a local pediatrician.
Remember that it is PROHIBITED to transport a person with seizures. This is fraught with complications. Therefore, do not demand immediate hospitalization from emergency doctors and do not allow them to take the child away until the condition stabilizes. If the convulsions were so short-lived that you did not even have time to get scared, much less call for help, do not forget about them. Be sure to see your doctor as soon as possible. We hope our article will help you navigate a difficult situation.
So, cramps are involuntary muscle contractions caused by irritation of certain brain structures that control movement. Seizures are divided into epileptic and non-epileptic. This division is important because these two groups have a completely different approach to treatment.
There are also tonic - more persistent and slow convulsions and clonic - fast, fragmentary. They can also have a mixed character - tonic-clonic. Although these names are not easy, in reality these 2 types of seizures are clearly distinguishable. Anyone who has seen both at least once in his life will never confuse them.
Most often, convulsions are a reflection of epileptic seizures. In this case, they can be generalized (general) or focal (local). Partial seizures involve seizures in one limb or on one side of the body. They indicate an area of the brain that is affected by arousal. During generalized seizures, the entire cerebral cortex, which is responsible for movement, is irritated, so all the muscles of the body are seized with convulsions. We will talk about epilepsy in more detail in future articles.
Now let's return to non-epileptic causes of seizures.
Febrile seizures. The most frequent seizures in children – febrile, i.e. caused by a rise in body temperature above 38 C. As the temperature rises, the metabolism in the brain cells and its blood supply change. The consequence of this is an increase in convulsive readiness. Typically, convulsions occur on the first day of a rise in temperature during infectious diseases: influenza, sore throat, etc. They look like twitching of the limbs against the background of loss of consciousness and an increase in the general tone of the body. The attack lasts 3-5 minutes and most often occurs once. The risk group is all children aged 9 to 20 months. What should you do in such a situation?
1. Call an ambulance.
2. Turn the child on his side, expose him as much as possible and keep him calm. Don't scream trying to bring him to consciousness.
3. Remove everything dangerous items to prevent injury. The child must be in safe place(corners of the bed, etc., in this case there is a danger).
4. Provide access to fresh air.
The examinations that you will undergo after such an episode include a visit to a neurologist and EEG recording. Don't get scared ahead of time. The presence of febrile seizures most often does not indicate any nervous disease. It is necessary to get checked, since 20% of such children are subsequently diagnosed with epilepsy.
Tetany. Tetany is caused by a decrease in calcium levels in the blood. A lack of calcium leads to increased excitability of the nervous tissue, as a result of which a series of discharges occur in it. Tetany is easy to recognize. Spasms of the hands and feet are characteristic. The spasm of the hand looks like an “obstetrician’s hand” - flexion in the metacarpophalangeal joints and extension in the interphalangeal joints, flexion in the radial and elbow joints. If the spasm affects the leg, then the foot and toes bend towards the sole with an inward turn. The danger of tetany is that laryngospasm (spasm of the glottis) may develop, making breathing difficult. If your seizures resemble tetany, tell your doctor. To begin with, he will conduct several functional tests, and then send you to analyze your hormone levels. Most common reason tetany – insufficiency of the parathyroid glands. However, it can be observed during hyperventilation (deep breathing) in patients with neuroses, with renal failure. It may also be associated with decreased magnesium levels or fluctuations in blood potassium levels. This applies mainly to sudden changes in concentrations, e.g. intravenous administration medications containing these electrolytes.
Multifocal myoclonus – jerky, irregular convulsive movements. They often appear in the context of confusion or daze. Such myoclonus may be accompanied by tremors and twitching. Usually occurs as a consequence of metabolic or toxic encephalopathy. In children it appears mainly as a consequence of apnea at birth.
In junior childhood epileptic seizures are easily confused with affective-respiratory attacks. Affective-respiratory attacks occur as a consequence of intense screaming in an offended or frightened child. They are characterized by holding their breath while inhaling, followed by turning blue, loss of consciousness, and decreased muscle tone or generalized tonic muscle tension. Sometimes against this background short-term clonic twitching occurs. After a few seconds, breathing, and with it the screaming, resumes. Confusion persists for a minute, after which the child returns to the interrupted activity. Seizures are observed mainly in children from 6 months of age. up to 4 years and then disappear without a trace. Basic therapy - psychological correction behavior of mother and child.
Often the “convulsions” are demonstrative – hysterical. In this case, they are bizarre, without a clear change in the tonic and clonic phases with arching of the body, kicking, moaning, screaming. It is characteristic that all this happens with unchanged consciousness. Help - remove the audience for whom the concert is given.
Brief clonic convulsions may occur during fainting. This happens when a fainting person does not get the opportunity to fall (sitting in a chair, on public transport). In this case, the fainting prolongs and, as a result, short-term convulsions occur. Their duration in this case does not exceed several seconds.
It is necessary to distinguish convulsions from hyperkinesis. These are involuntary violent movements associated with the defeat of the system responsible for the smoothness, economy and emotional coloring of movements. There are several types of hyperkinesis: tremor (shaking), dystonia, chorea, athetosis, ballism, tics, etc. We will describe the most common ones. Surely you have seen such patients on the street. Don't be afraid of them - basically, they have adequate mental and mental development, they themselves suffer from their defect. So, dystonia is involuntary slow repetitive movements, rotation, flexion or extension of various parts of the body with the formation of pathological postures. Chorea is a continuous stream of fast, nonrhythmic, chaotic jerks. Athetosis – slow worm-like movements in the arms and body. Sometimes athetosis looks like a corkscrew twist.
Read about the epileptic nature of seizures in the next article.
Obstetrician syndrome
In the medical literature, Trousseau's symptom refers to two conditions:
Recurrent thrombophlebitis in cancer of internal organs (it is, however, more often called Trousseau's syndrome). Thrombophlebitis affects both superficial and deep veins, often changes localization (thrombophlebitis migrans) and manifests itself as chains of painful nodules along the affected veins. Veins are affected haphazardly, simultaneously or sequentially. Trousseau syndrome develops due to changes in malignant neoplasm prothrombin level.
It is observed, as a rule, with adenocarcinomas of the pancreas or lung, as well as stomach, breast or prostate gland. Trousseau described it in 1861, and in 1867 he discovered it as one of the manifestations of pancreatic cancer, which ultimately killed him.
Carpal spasm (hand spasm during tetany). It is often associated with foot flexor spasm (carpopedal spasm), extension posture, and opisthotonus.
During carpal spasm, the wrist flexors and finger extensors contract. The thumb is bent and brought to the palm, the rest are bent at the metacarpophalangeal joints, but straightened at the interphalangeal joints. The hand assumes a position similar to that given to it by the doctor performing a vaginal examination, which is why Trousseau called carpal spasm “the hand of the obstetrician” (in French, main d’accoucheur).
Under what conditions is the “obstetrician’s hand” symptom observed?
For any predisposing to tetany: alkalosis, hypocalcemia, hypomagnesemia, hypophosphatemia.
How to provoke carpal spasm to reveal hidden tetany?
Press the shoulder with the sphygmomanometer cuff until the pulse disappears in the radial artery for 5 minutes. For hypocalcemia, the sensitivity of this test is 66%, but in 4% of cases the result is false positive, so it does not replace the determination of serum calcium levels.
Instead of provoking carpal spasm, you can determine Chvostek's symptom, indicating increased excitability - twitching of the facial muscles when tapping on the temporal bone before auricle at the exit point of the facial (VII cranial) nerve.
The sensitivity of Chvostek's sign for latent tetany is low (27%), and the frequency false positive results very high (19-74% in children and 4-29% in adults).
Who is Trousseau?
Armand Trousseau () - one of the greatest figures in Parisian medicine of the 19th century. He was the first in France to perform tracheostomy, introduce thoracentesis, and coin the term “aphasia.” He was an excellent clinician and teacher, renowned as a lecturer who presented clinical observations with the grace of a novelist, and as an ardent advocate of teaching methods. clinical disciplines at the patient's bedside.
It was Trousseau who introduced into widespread use such eponyms as Addison's disease, Graves' disease and Hodgkin's disease. He was deeply respected and loved by students and colleagues. His students include Potin, Lasegue, Brown-Séquard and da Costa. In addition, Trousseau was involved in political activities. He was a participant in the revolution of 1848, one of the creators of its legislative body.
His advice to students remains relevant 150 years after his death: “Watch the practice of many doctors; Do not unconditionally assume that your teacher is always right, that he is the best. Don't be shy about admitting your own ignorance. In fact, recognition of it is on the tip of every doctor’s tongue. Do not exaggerate your medical merits by mastering scientific facts. They are only a condition for future professional achievements, allowing you to take the next step to the heights of mastery.”
Who is Khvostek?
Frantisek Chvostek () - an Austrian surgeon originally from the Czech Republic, in 1867 he described the symptom named after him. In addition to surgery, he studied and treated diseases of the nervous system, including experimental research in the field of electrotherapy.
Obstetrician syndrome
During spasm, the arm is in a state of extension, the forearm is bent in semiflexion, and the shoulder is in a state of adduction (Trousseau's symptom - the obstetrician's hand).
On the lower extremities there is increased extension of the thigh and lower leg with flexion of the foot and toes. In severe cases, cramps can involve all the muscles of the face, causing it to become distorted. The face takes on a characteristic expression, the forehead is wrinkled, the lips are contracted and protruded forward. The muscles of the eyes, tongue, larynx, and the diaphragm also take part in a spastic attack. With convulsions of the muscles of the larynx, which is more often observed in children, laryngospasms occur, with suffocation, cyanosis; with prolonged spasm, severe asphyxia appears with loss of consciousness, which can result fatal. Often, patients with chronic hypoparathyroidism experience trophic disorders: dry skin, brittle bones, hair loss, cataracts, significant weight loss. Patients often experience tachycardia, arrhythmia, and compressive pain in the heart area. The electrocardiogram shows an increase QT interval, which is caused by hypocalcemia.
A constant symptom of hypoparathyroidism is a violation of mineral metabolism - hypocalcemia up to 5-6 mg%, hyperphosphatemia up to 7-10 mg%, hypocalciuria and hypophosphaturia. Impaired function of the organ of vision is expressed in convergence disorders, eyelid spasms, diplopia, nystagmus and the development of cataracts. During an attack, you can observe a narrowing or dilatation of the pupils and a slow reaction. With spasm of the intercostal muscles, abdominal muscles and diaphragm, significant respiratory distress is observed.
The autonomic nervous system is in a state of increased excitability with a tendency to vasomotor phenomena.
Functional disorders gastrointestinal tract expressed in increased peristalsis, constipation followed by diarrhea, increased secretion gastric juice. Gastric or duodenal ulcers may often develop.
By clinical course There are acute, chronic and latent forms of parathyroid tetany.
In the acute form of tetany, attacks are often repeated, last a long time, and can occur unexpectedly.
The development of tetany in acute form after any trauma and strumectomy indicates complete or almost complete shutdown of the function of the parathyroid glands. Acute form tetany may end in recovery or progress to chronic form depending on the nature of the disease, treatment, etc. This form has a less severe course, attacks are rare. In its origin, provoking moments, overheating or hypothermia, physical activity, mental trauma, pregnancy, and acute infections are important.
Seasonal exacerbations and diseases occur in spring and autumn. Often, patients with chronic hypoparathyroidism exhibit trophic disorders: dry skin, brittle nails, hair loss and weight loss. Changes in the teeth are reduced to enamel defects; teeth break and crumble easily.
Recognition of idiopathic latent hypoparathyroidism presents certain difficulties. This form is characterized by the absence of spontaneously occurring attacks, which can occur under the influence of various provoking factors. Idiopathic tetany most often occurs in at a young age, men are more often affected. The presence of changes in calcium and phosphorus metabolism typical of hypoparathyroidism gives grounds to classify idiopathic tetany as a parathyroid form associated with congenital inferiority of the parathyroid glands.
Complaints from patients with a latent form of tetany are usually associated with disturbances in cardiac activity: they complain of palpitations, chest pain, a feeling of tightness in the chest, headaches, fainting, and often complain of goosebumps crawling in their fingers. Physical and X-ray studies internal organs show no changes. The simplest way is to identify Chvostek's symptom, which is based on increased excitability of the facial nerve when it is mechanically irritated. In response to irritation, the upper lip twitches (Khvostek I), or the upper lip and nose (Khvostek II), or twitching of the corner of the mouth is added (Khvostek III).
Diagnosis and differential diagnosis. It is necessary to think about the possibility of hypoparathyroidism if patients, after partial removal of the thyroid gland, experience signs of topical seizures. When making a diagnosis, one should also differentiate tetany from hysteria and epilepsy. In patients with hysteria and epilepsy, calcium and phosphorus metabolism disorders are not detected.
One should also keep in mind hypoglycemic convulsions, in which characteristic symptoms are observed: a feeling of hunger, weakness, and pale skin. The question is resolved by examining blood sugar and calcium levels.
Treatment of hypoparathyroidism. When treating an attack of tetany, it is necessary to administer 10 ml of 10% calcium chloride intravenously, 2-4 ml of parathyrsocrine intramuscularly.
Intravenous administration of a 10% solution of calcium chloride or a 10% solution of calcium gluconate usually quickly stops an attack of convulsions during tetany, which is very important for laryngospasm, when this is the main measure during first aid.
Depending on the duration and frequency of attacks, injections of calcium chloride and parathyroid hormone are recommended 2-3 times a day under the control of calcium levels in the blood.
In the inter-iristune period, calcium supplements are prescribed in the form of a 10% solution of calcium chloride, one tablespoon 3 times a day, or calcium gluconate in tablets, 3-4 tablets a day. At the same time prescribed orally alcohol solution vitamin D2 ME 2 times a day.
The diet of patients should contain a large amount of calcium, and therefore dairy products are recommended.
DIC syndrome in obstetrics
Pregnant women are considered one of the most vulnerable categories of patients, who are susceptible not only to infectious and respiratory diseases, but also to various disorders in the functioning of internal organs. Pregnant women may experience complications from the nervous, vascular and digestive systems, as well as endocrine disorders, developing against the background of changes in hormonal levels. Negative changes can also occur in the hematopoietic system, as well as hemostasis - a biological system that ensures the vital functions of the body, maintains the fluid state of the blood and promotes rapid recovery skin and mucous membranes after injury.
DIC syndrome in obstetrics
A fairly common pathology of hemostasis during pregnancy is DIC syndrome. This is the process of active leaching of thromboplastin (an external stimulator of the coagulation process) from tissues and organs, which leads to impaired blood clotting. IN medical practice This condition is called “disseminated intravascular coagulation.” The syndrome is dangerous due to its asymptomatic course and the rapid development of systemic coagulopathy, therefore all pregnant women should be observed by a gynecologist or obstetrician-gynecologist at their place of residence throughout the entire pregnancy.
Why do hemostasis disorders occur during pregnancy?
Minor disorders of hemostasis, accompanying signs of disseminated intravascular coagulation, can be explained by physiological processes occurring in a woman’s body during pregnancy, but in the vast majority of cases (more than 94%), such symptoms are the result of certain pathologies.
Fetal death
One of the causes of acute DIC at any stage of gestation is intrauterine fetal death and pregnancy loss. This can happen for a number of reasons, but the most common ones are:
- maternal intake of toxic drugs and potent drugs;
- amniotic fluid embolism (amniotic fluid entering the pulmonary arteries and their branches);
- placenta previa or abruption;
- acute alcohol or drug intoxication of the fetus;
- tumors of the outer cellular layer of the placenta (trophoblast).
One of the causes of pathology is fetal death
Miscarriage of pregnancy can occur at any stage, but disseminated intravascular coagulation syndrome appears only 4-6 weeks after antenatal fetal death. The pathology is complicated by acute intoxication and a high risk of toxic products entering the systemic bloodstream, which can lead to the development of sepsis and bone marrow inflammation.
Determine frozen pregnancy early is possible only with the help ultrasound examination, as well as a blood test for the level of human chorionic gonadotropin, which will be significantly lower than the gestational norm. After weeks, fetal death can be suspected by the absence of movements and heartbeat.
Important! DIC syndrome of the 4th degree can lead to the death of a woman, therefore, if there are any signs indicating a possible termination of pregnancy, you must immediately contact the pregnancy pathology department at the regional maternity hospital.
Preeclampsia and initial signs of preeclampsia
Preeclampsia (“late toxicosis”) is the most common pathology of pregnant women, encountered by almost 60% of women. Preeclampsia has three main signs that allow diagnosing the pathology at an early stage:
- stable increase blood pressure with a weak response to drug correction;
- detection of protein or traces thereof in urine;
- swelling on the face and limbs, most often having a generalized form.
High blood pressure during pregnancy
Women diagnosed with gestosis should be under constant supervision of specialists, since progressive forms of pathology can cause the development of preeclampsia - a disorder cerebral circulation against the background of late toxicosis of the second half of pregnancy. Another danger of gestosis is damage to endothelial cells (single-layer flat cells covering the surface of the cardiac cavity, lymphatic and blood vessels). If the integrity of the endothelium is compromised, disseminated intravascular coagulation syndrome may develop, requiring close monitoring and timely emergency care.
Symptoms of gestosis during pregnancy
Other reasons
The causes of DIC syndrome may be of infectious origin. Infection of amniotic fluid, prolonged bacterial infections internal organs in the mother, increasing the risk of bacteria and their toxins entering the bloodstream - all this can cause coagulation disorders and systemic coagulopathy, therefore it is important to promptly treat any diseases of an infectious nature and follow all doctor’s prescriptions. Some women refuse to take antibiotics, believing that they may harm the unborn child, but it has long been proven that the consequences of using antimicrobial drugs are much milder compared to the possible complications if the infection gets to the fetus.
90% of children have no symptoms after birth due to intrauterine infection
Other causes of acute disseminated intravascular coagulation may include:
- surgical operations performed during pregnancy with blood or plasma transfusion (the risk increases if blood incompatible with the group or Rh factors was used for the transfusion);
- damage to red blood cells or platelets;
- long-term uterine bleeding leading to the development of hemorrhagic shock;
- uterine rupture;
- atony of the uterine muscles (decreased muscle tone);
- medical massage of the uterus.
Infectious diseases, burns, skin injuries, states of shock pathologies of the placenta of various origins can also cause coagulopathy, so it is important for a pregnant woman to undergo the examinations prescribed by the doctor on time and take the necessary tests.
Symptoms: when should you see a doctor?
The danger of DIC syndrome lies in its practically asymptomatic course. In most cases, pathology can be determined only after laboratory diagnostics, which can determine hematological disorders (changes in blood chemical parameters). With grade 3 and 4 disseminated intravascular coagulation syndrome, a woman may experience specific symptoms, the main one of which is hemorrhagic rash. It looks like a small pink or light red spot, is localized on the surface of the epidermis and appears as a result of rupture of small blood vessels and hemorrhage under the skin.
Coagulation of blood flowing from the uterine cavity
Other signs that may indicate the need to seek medical help include:
- frequent nosebleeds in the absence of injuries or other damage;
- bleeding gums (provided that the woman does not suffer inflammatory diseases periodontal and periodontal disease, as well as gingivitis);
- bruises that form on various parts of the body without exposure to any damaging factors;
- uterine bleeding and spotting;
- poor wound healing;
- bleeding at injection sites.
Nosebleed
A woman may also feel constant weakness, her performance is impaired, and increased drowsiness appears. With frequent bleeding, constant headaches, dizziness, and a feeling of pressure in the temporal and occipital areas are noted. All these signs are a reason to carry out diagnostic measures, therefore, if they occur, you should immediately consult a doctor managing your pregnancy.
Target organs in DIC syndrome
Symptoms of pathology depending on the stage
In total, there are 4 stages of DIC syndrome, each of which has its own clinical features. For a more accurate diagnosis and determination of the pathogenesis of existing disorders, the doctor needs to collect a complete anamnesis and conduct laboratory diagnostics.
Table. Stages of disseminated intravascular coagulation syndrome and their symptoms.
Spasmophilia (tetany) is a painful condition in which there is increased neuromuscular excitability with a tendency to convulsions and spastic manifestations, usually detected in early spring during a period of increased insolation. Occasionally occurring in adults, spasmophilia primarily affects children aged 6 months to 3 years, premature babies and those who are bottle-fed or mixed-fed. Spasmophilia occurs when there is a calcium deficiency in the child’s body and is often combined with rickets.
Causes of spasmophilia in children
Spasmophilia develops as a result of a lack of calcium in the blood due to taking high doses of vitamin D in the treatment of rickets or with increased insolation and excessive formation of this vitamin in the skin. Its hyperproduction in the body has Negative influence on the function of the thyroid gland, provokes the absorption of calcium and phosphorus salts in the intestine and their further reabsorption (reabsorption) in renal tubules, which is the cause of alkalosis. Active deposition of calcium in the bones leads to a decrease in its amount in the blood - hypocalcemia, and also increases neuromuscular excitability, leading to seizures.
Symptoms of latent spasmophilia
The disease can have a hidden (latent) or obvious form. Hidden form spasmophilia in children is very difficult to determine - they are actually healthy, they have normal physical and psychomotor development, but symptoms of rickets often appear. There are a number of symptoms characteristic of spasmophilia that confirm its latent form. Let's name some of them:
- Chvostek's sign. Characterized by contraction facial muscles face with light tapping on the cheek between the corner of the mouth and the earlobe along the trunk of the facial nerve;
- Weiss's sign. It is characterized by the occurrence of contraction of the muscles of the forehead and eyelids when tapping with a percussion hammer in the area of the edge of the orbit from the outside;
- Trousseau's sign. When the shoulder is intensively pulled with a tourniquet or cuff, a convulsive contraction of the hand muscles occurs in the overtightened arm. This leads to the position of the hand in the form of an “obstetrician’s hand”. Convulsions in spasmophilia are preceded by a feeling of numbness and pain in the fingers;
- Maslov's symptom. In children suffering from spasmophilia, unlike healthy ones, when a needle is pricked in the leg, not only rapid breathing is observed, but also apnea (short-term cessation of breathing) recorded by a pneumograph.
The latent form of spasmophilia in children is determined quite often. Under the influence of certain factors, such as fear, vomiting, sudden exposure to sunlight, or increased temperature due to an infectious disease, it can become obvious. If spasmophilia is detected, treatment must be carried out immediately.
Clinical picture and symptoms of obvious spasmophilia
An obvious form of spasmophilia in children can be expressed by laryngospasm, carpopedal spasm, eclampsia, or a combination of them:
- Laryngospasm. One of the most common forms of spasmophilia, also called “birthmark,” is characterized by a sudden acute narrowing of the glottis, with its possible partial or complete closure, which occurs during crying or fright. With moderate manifestations of laryngospasm, the child’s skin turns pale, cold sweat appears, and a change in voice occurs with hoarse or sonorous inhalation. The attack can last up to 2 minutes, then when breathing is restored, the child falls asleep. In the absence of adequate treatment for spasmophilia, attacks can be repeated; during severe laryngospasm, complete cessation of breathing and loss of consciousness are sometimes observed; in the most severe cases, death is possible;
- Carpopedal spasm. Symptoms of spasmophilia in this form of the disease are tonic spasms of the hands, feet and face. In this case, the child has arms bent at the elbows, hands down with characteristic symptom Trousseau, bent legs and feet. Attacks of spasmophilia can last from several minutes to several hours, with reactive swelling of the hand and foot appearing; spasms of the respiratory muscles are also possible, threatening to delay and stop breathing, and spasms of the heart muscle with possible cardiac arrest;
- Eclampsia. The rarest and most dangerous form spasmophilia, manifested by attacks of clonic-tonic convulsions, spreading to the entire musculature. With a mild course, facial muscle spasms, the appearance of cyanosis, intermittent breathing and numbness of the child are characteristic. During a severe attack of spasmophilia, convulsions of the whole body, loss of consciousness, tongue biting, involuntary urination and defecation occur; the attack can last up to 25 minutes. In severe cases, respiratory and cardiac arrest is possible; eclampsia most often affects children in the first year of life.
These forms of spasmophilia pose a threat to the health and life of children and require emergency medical care for immediate resuscitation.
Spasmophilia in adults
Spasmophilia in adults is much less common than in children; it can be caused by the following reasons:
- Surgical operations to remove the parathyroid glands;
- Hemorrhages;
- Tumors that have a negative effect on the thyroid gland.
In some cases of spasmophilia in adults, its etiology remains unknown. Factors that provoke the detection of the disease in a latent form include pregnancy, lactation, infectious diseases, nervous tension. To prevent attacks of spasmophilia, it is recommended to avoid stressful situations, be able to control your breathing and relax, include foods containing calcium, magnesium and phosphorus in your diet.
Treatment of spasmophilia
When diagnosing spasmophilia in children, the age of the child, the time of year, the presence of signs of rickets, and laboratory research symptoms of hypocalcemia, hypophosphatemia, and metabolic alkalosis are determined.
In the treatment of spasmophilia, relief of convulsive syndrome is carried out with the help of anticonvulsants - seduxen, relanium, magnesium sulfate, gamma-aminobutyric acid. To restore calcium levels in the blood and eliminate alkalosis, use a 10% solution of calcium gluconate and 3-5% ammonium chloride. In the future, vitamin therapy is carried out, and after normalization of calcium levels in the blood, therapeutic doses vitamin D
If an attack of laryngospasm develops, before the ambulance arrives, it is necessary to lay the patient on a hard surface, ensure rest and access to air, sprinkle the face and body with cold water, ammonia or other means to cause irritation of the nasopharyngeal mucosa. To relieve an attack of spasmophilia, doctors administer a solution of calcium and magnesium intravenously, and intramuscularly sedatives. If the measures taken are ineffective and there is no breathing, tracheal intubation is necessary, as well as indirect massage heart when it stops.
Prevention of spasmophilia consists in timely diagnosis and adequate treatment of rickets.
An attack of convulsions is usually preceded by a feeling of numbness, crawling in the area of the upper lip, fingers and toes, coldness of the extremities, and a feeling of stiffness. Then painful tonic and clonic spasms of individual muscle groups develop: limbs, face, torso. Cramps are observed mainly in the flexor muscles, so the hand takes the characteristic position of the “obstetrician’s hand.”
With tetany of the flexor muscles lower limbs the foot bends inward, the toes bend toward the sole (“horse foot”). Convulsions of the facial muscles are accompanied by trismus, the formation of a “fish mouth”.
The spread of cramps to the neck muscles can cause laryngospasm, accompanied by shortness of breath, cyanosis, and sometimes asphyxia. Pylorospasm with vomiting, nausea, and acidosis may develop; spasms of the intestinal muscles, Bladder. Spasm coronary vessels heart accompanied sharp pain in the area of the heart. Attacks of tetany are provoked by various stimuli: painful, mechanical, thermal, hyperventilation.
Tapping on the trunk of the facial nerve near the external auditory canal causes contraction of the forehead muscles, upper eyelid, mouth (Chvostek's sign), tapping along the superior branch of the facial nerve at the outer edge of the orbit leads to contraction of the orbicularis eyelid muscle; pulling the shoulder with a tourniquet - to the characteristic position of the hand - "obstetrician's hand" (Trousseau's symptom).
With a long course of the disease, during the interictal period, patients are concerned about sweating, blurred vision due to impaired accommodation, ringing in the ears, and decreased hearing. Hypocalcemic cataracts, brittle nails, brittle teeth and caries develop. Mental changes are observed: decreased intelligence, memory impairment, neuroses.
Description
Removal or damage to the parathyroid glands during surgery, their damage due to infections, intoxications, autoimmune disorders, decreased tissue sensitivity to the action of parathyroid hormone.
Insufficient release of parathyroid hormone, leading to disturbances in calcium-phosphorus homeostasis (hypocalcemia and hyperphosphatemia). Neuromuscular excitability increases, and a tendency to develop convulsive syndrome appears.
Treatment
To relieve an attack of tetany, 10-20 ml of a 10% solution of calcium chloride or gluconate is injected intravenously, parathyroidin - 2 ml intramuscularly.
To prevent attacks, calcium supplements are prescribed orally, drugs that improve the absorption of calcium in the intestine, anabolic steroid, a diet rich in calcium (milk, cheese, cabbage, lettuce, radishes, apricots, strawberries, lemons).
Great Medical Encyclopedia
OBSTETRIC TURN, an operation, with the help of a swarm you can change a given position of the fetus, for some reason unfavorable for the course of labor, to another, more advantageous one, and, of course, always only to a longitudinal position. (History of A. p. see Obstetrics ... ...
RUDOLFI- Karl (Rudolphi Karl Asmund, 1771 1832), founder of helminthology; He graduated from the faculties of philosophy and medicine in Greifswald, and held the department of anatomy and physiology in Berlin for 22 years. I became interested in helminthology during my student years... ... Great Medical Encyclopedia
Spasmophilia- SPASMOPHILIA is a disease of children early age, characterized by a tendency to tonic and clonic-tonic convulsions due to hypocalcemia. Etiology and pathogenesis. The calcium content in the blood serum during rickets decreases in ... ... Wikipedia
Tetany- I Tetania (tetania; Greek tetanos tension, convulsion) is a pathological condition characterized by convulsive syndrome and increased neuromuscular excitability due to a decrease in the concentration of ionized calcium in the blood serum, as ... ... Medical encyclopedia
Smellie-Siegemundin reception- (W. Smellie, 1697 1763, English obstetrician; J. Siegemundin, 1648 1705, German midwife; synonym double manual technique) obstetric rotation of the fetus onto the leg, in which one hand of the obstetrician, inserted into the uterus, pushes the head up, and the other pulls the leg by... ... Large medical dictionary
Smelley - Siegemundin reception- (W. Smellie, 1697 1763, English obstetrician; J. Siegemundin, 1648 1705, German midwife; syn. double manual technique) obstetric rotation of the fetus onto the leg, in which one hand of the obstetrician, inserted into the uterus, pushes the head up, and the other pulls... ... Medical encyclopedia
Spasmophilia- I Spasmophilia (spasmophilia; Greek spasmos cramp, spasm + philia tendency; synonym: rickitogenic tetany, spasmophilic diathesis) is a pathological condition that occurs in children with rickets in the first 6-18 months. life; characterized by... ... Medical encyclopedia
Hypocalcemic crisis- Thetan attack... Wikipedia
Maine obstetrician- * main d accoucheur. honey. Hand deformity. Obstetrician's hand. BME 1934 411 … Historical Dictionary of Gallicisms of the Russian Language
Rigid person syndrome- Syn.: The “numb person” syndrome. Mersch-Woltmann syndrome. Progressive symmetrical muscle rigidity, usually manifesting in men aged 20–40 years. Muscle tension and pain muscle spasms grow over several...
Bullet phenomenon- spasm of the muscles of the hand (“obstetrician’s hand”) during passive extension of the arm (with spasmophilia, tetany) ... encyclopedic Dictionary in psychology and pedagogy
