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Tetany is a symptom characterized by involuntary muscle contractions and overly stimulated peripheral nerves. It is most commonly associated with low blood calcium levels, or hypocalcemia, although it can also appear with other metabolic irregularities, such as electrolyte imbalances. Hypocalcemia can be caused by a decreased level of parathyroid hormone (PTH) or, more rarely, increased resistance to its activity. Primary hyperparathyroidism (1HPT) and malignancy-associated hypercalcemia are the most frequent causal diseases for hypercalcemia. Therefore, hypercalcemia can cause muscle tetany if it results in hypocalcemia.
| Characteristics | Values |
|---|---|
| Tetany | A symptom involving involuntary contraction of muscles that leads to painful muscle cramps. |
| Cause | Hypocalcemia (low blood calcium levels) is the most common cause. |
| Other causes | Hypomagnesemia, alkalosis, metabolic irregularities, electrolyte imbalances, disorders affecting the acid-base balance, and an excess of phosphate. |
| Symptoms | Spasms of the voice box (laryngospasm), vomiting, generalized muscle cramps, seizures, decreased cardiac function, numbness around the mouth, a burning or tingling sensation in the hands and feet (paresthesia), and sensory disturbances. |
| Treatment | Severe tetany requires urgent intravenous (IV) calcium replacement. Calcium gluconate and calcitriol can also be used. |
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What You'll Learn
Hypocalcemia is the primary cause of muscle tetany
Tetany is a symptom characterised by involuntary muscle contractions that lead to painful muscle cramps, spasms of the voice box (laryngospasm), and sensory disturbances. It is most commonly associated with low blood calcium levels, or hypocalcemia, although it can also be caused by other metabolic irregularities.
Tetany is a classic sign of hypocalcemia, which refers to the presence of low calcium levels in the blood. Maintaining stable calcium levels is important for the adequate functioning of many cellular processes, such as neuronal activity, muscular contraction, hormone secretion, and blood coagulation. Blood calcium levels are regulated by the parathyroid hormone (PTH), which is released into the circulation when calcium levels are too low. Hypocalcemia can result from a decreased level of PTH or, more rarely, increased resistance to its activity.
The calcium in the blood helps nerves work, makes muscles squeeze together, helps blood clot, and helps the heart work properly. Many different health conditions can cause hypocalcemia, but it is often caused by low levels of parathyroid hormone (hypoparathyroidism) or vitamin D in the body. Hypocalcemia can also be caused by hypomagnesemia, which is when the levels of magnesium in the blood are too low.
Mild symptoms of tetany include numbness around the mouth, muscle spasms, and a tingling or burning sensation in the hands and feet (paresthesia). Severe symptoms include difficulty breathing due to muscle spasms of the voice box (laryngospasm), seizures, and decreased cardiac function. Severe tetany generally requires urgent intravenous (IV) calcium replacement.
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Hypocalcemia is caused by a lack of parathyroid hormone
Tetany is a symptom characterised by involuntary muscle contractions that lead to painful muscle cramps. It is most commonly associated with low blood calcium levels, or hypocalcemia. Hypocalcemia, in turn, is often caused by abnormal levels of parathyroid hormone (PTH) or vitamin D in the body.
Parathyroid hormone is released into the circulation when calcium levels are too low. It is produced by the parathyroid glands, which are four small pea-sized glands behind the thyroid in the neck. Parathyroid hormone helps regulate calcium and phosphorus levels in the blood. When the parathyroid glands do not produce enough parathyroid hormone, this causes calcium levels in the blood to drop and phosphorus levels to rise.
There are several causes of hypoparathyroidism, or a lack of parathyroid hormone. One of the most common causes is neck surgery, during which the parathyroid glands may be damaged or removed. Hypoparathyroidism can also be caused by an inherited disorder, where a person is born without parathyroid glands or with glands that do not work correctly. In some cases, extensive cancer radiation treatment of the head or neck can destroy the parathyroid glands.
Other causes of hypocalcemia include vitamin D deficiency, kidney failure, certain medications, and pseudohypoparathyroidism, where the body does not respond properly to normal levels of parathyroid hormone.
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Tetany is a symptom involving involuntary muscle contractions
Tetany is a symptom characterised by involuntary muscle contractions, which lead to painful muscle cramps. It is often associated with low blood calcium levels, or hypocalcemia, although it can also be caused by other metabolic irregularities, such as electrolyte imbalances. Tetany is a classic sign of hypocalcemia, which refers to the presence of low calcium levels in the blood.
Calcium plays an important role in the adequate functioning of many cellular processes, such as neuronal activity, muscular contraction, hormone secretion, and blood coagulation. Blood calcium levels are regulated by the parathyroid hormone (PTH), which is released into the circulation when calcium levels are too low. Hypocalcemia can result from a decreased level of PTH or, more rarely, increased resistance to its activity. Tetany can also be caused by a vitamin D deficiency.
The symptoms of tetany range from mild to severe. Mild symptoms include numbness around the mouth, a burning or tingling sensation in the hands and feet, and muscle spasms. More severe symptoms include spasms of the voice box (laryngospasm), which can cause breathing difficulties, seizures, and decreased cardiac function, such as an irregular heart rhythm. Severe cases of tetany can be life-threatening and require immediate medical treatment.
Tetanic seizures are distinct from muscle cramps caused by tetanus, which is an infectious disease characterised by central nervous system hyperexcitability. Tetanus results in muscle rigidity and spasms, but these are due to a lack of inhibition to the neurons that supply muscles, rather than involuntary contractions.
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Tetany is caused by an electrolyte imbalance
Tetany is a symptom, not a disease. It is characterised by involuntary muscle contractions and overly stimulated peripheral nerves. It can be a sign of mild electrolyte problems, which can occur due to parathyroid disease or a new medication. It can also be a sign of more severe electrolyte changes, such as those caused by severe bleeding or kidney disease.
The types of electrolyte imbalances that can cause tetany include hypocalcemia, hypomagnesemia, and hypokalemia. Hypocalcemia is the most common cause of tetany. It occurs when blood calcium levels are too low, which can be caused by low levels of parathyroid hormone (hypoparathyroidism) or vitamin D in the body. Hypomagnesemia is when blood magnesium levels are too low, and hypokalemia is when blood potassium levels are too low.
Mild symptoms of tetany include numbness around the mouth, painful muscle cramps, and a burning or tingling sensation in the hands and feet, known as paresthesias. More severe symptoms include spasms of the voice box (laryngospasm), which can cause breathing difficulties, and decreased cardiac function, such as an irregular heart rhythm (arrhythmia).
The short-term goal for treating tetany is to correct the electrolyte imbalance, usually through calcium supplementation. The long-term goal is to diagnose and treat the underlying condition causing the electrolyte imbalance.
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Severe tetany requires urgent intravenous calcium replacement
Tetany is a symptom characterised by involuntary muscle contractions that lead to painful muscle cramps, spasms of the larynx (voice box), and sensory disturbances. It is most commonly associated with low blood calcium levels (hypocalcemia) but can also be caused by other metabolic irregularities. Severe tetany can lead to life-threatening complications and requires urgent medical attention.
Severe tetany often causes spasms of the voice box, which can make breathing difficult and lead to high-pitched sounds while breathing (laryngeal stridor). It can also cause vomiting, generalised muscle cramps, seizures, and decreased cardiac function, such as an irregular heart rhythm (arrhythmia). In some cases, severe tetany can lead to rhabdomyolysis, a potentially life-threatening condition caused by muscle breakdown and muscle death.
As severe tetany can have serious consequences, it requires urgent intravenous (IV) calcium replacement. This is because hypocalcemia is the most common cause of tetany, and correcting the calcium deficiency can help alleviate symptoms. Intravenous calcium replacement can rapidly raise calcium levels in the blood, which is crucial when symptoms are severe.
The recommended dose of elemental calcium in healthy adults is 1-3 g/day. However, in cases of symptomatic or severe hypocalcemia with cardiac arrhythmias or tetany, higher doses of 100-300 mg of elemental calcium in 50-100 mL of 5% dextrose in water (D5W) are given over 5-10 minutes. This dosage raises the ionized level to 0.5-1.5 mmol and should last 1-2 hours. It is important to monitor serum calcium levels every 4-6 hours to maintain the desired range of 8-9 mg/dL.
Additionally, it is crucial to address the underlying cause of tetany. In some cases, hypocalcemia may be due to low levels of parathyroid hormone (PTH) or vitamin D deficiency. Therefore, identifying and treating the cause of hypocalcemia is essential for long-term management.
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Frequently asked questions
Hypercalcemia is a condition where there are elevated levels of calcium in the blood. Normal calcium levels range from 8.2-10.2 mg/dL, mild hypercalcemia occurs when this level raises to 12mg/dL, and severe hypercalcemia is classified as serum calcium at or above 14mg/dL.
Hypercalcemia is usually caused by overactive parathyroid glands, cancer (particularly lung, breast, and multiple myeloma), certain medications (such as lithium and thiazide diuretics), dehydration, and excessive intake of calcium and vitamin D supplements.
Symptoms of hypercalcemia range from mild to severe and can include fatigue, muscle weakness, cognitive impairments, low muscle tone, sluggish reflexes, gastrointestinal issues (pain, nausea, vomiting), bone pain, osteoporosis, osteomalacia, arthritis, pathological fractures, and in severe cases, coma and cardiac arrest.
Treatment for hypercalcemia depends on the underlying cause and severity. It may involve medications, interventions to lower blood calcium levels, hydration, dietary changes, and limiting calcium intake. In severe cases, dialysis may be required.
No, hypercalcemia does not directly cause muscle tetany. Tetany is typically associated with hypocalcemia (low calcium levels) and is characterized by involuntary muscle contractions and irritable nerves. However, hypercalcemia can lead to muscle weakness and, in severe cases, arrhythmias and cardiac arrest.
