Tetany or tetanic

seizure An epileptic seizure, informally known as a seizure, is a period of symptoms due to abnormally excessive or synchronous neuronal activity in the brain. Outward effects vary from uncontrolled shaking movements involving much of the body with los ...

is a

medical sign Signs and symptoms are the observed or detectable signs, and experienced symptoms of an illness, injury, or condition. A sign for example may be a higher or lower temperature than normal, raised or lowered blood pressure or an abnormality showin ...

consisting of the involuntary contraction of

muscle Skeletal muscles (commonly referred to as muscles) are organs of the vertebrate muscular system and typically are attached by tendons to bones of a skeleton. The muscle cells of skeletal muscles are much longer than in the other types of muscl ...

s, which may be caused by disorders that increase the

action potential An action potential occurs when the membrane potential of a specific cell location rapidly rises and falls. This depolarization then causes adjacent locations to similarly depolarize. Action potentials occur in several types of animal cells, ...

frequency of muscle cells or the nerves that innervate them. Muscle cramps caused by the disease

tetanus Tetanus, also known as lockjaw, is a bacterial infection caused by ''Clostridium tetani'', and is characterized by muscle spasms. In the most common type, the spasms begin in the jaw and then progress to the rest of the body. Each spasm usually ...

are not classified as tetany; rather, they are due to a lack of inhibition to the neurons that supply muscles.

Tetanic contraction A tetanic contraction (also called tetanized state, tetanus, or physiologic tetanus, the latter to differentiate from the disease called tetanus) is a sustained muscle contraction evoked when the motor nerve that innervates a skeletal muscle emits ...

s (physiologic tetanus) are a broad range of

muscle contraction Muscle contraction is the activation of tension-generating sites within muscle cells. In physiology, muscle contraction does not necessarily mean muscle shortening because muscle tension can be produced without changes in muscle length, such as ...

types, of which tetany is only one.

Signs and symptoms

Tetany is characterized by contraction of distal muscles of the hands (carpal spasm with extension of interphalangeal joints and adduction and flexion of the metacarpophalangeal joints) and feet (pedal spasm) and is associated with tingling around the mouth and distally in the limbs.

Causes

* The usual cause of tetany is a deficiency of

calcium Calcium is a chemical element with the symbol Ca and atomic number 20. As an alkaline earth metal, calcium is a reactive metal that forms a dark oxide-nitride layer when exposed to air. Its physical and chemical properties are most similar to ...

. An excess of

phosphate In chemistry, a phosphate is an anion, salt, functional group or ester derived from a phosphoric acid. It most commonly means orthophosphate, a derivative of orthophosphoric acid . The phosphate or orthophosphate ion is derived from phospho ...

(high phosphate-to-calcium ratio) can also trigger the spasms. * Underfunction of the

parathyroid Parathyroid glands are small endocrine glands in the neck of humans and other tetrapods. Humans usually have four parathyroid glands, located on the back of the thyroid gland in variable locations. The parathyroid gland produces and secretes par ...

gland can lead to tetany. * Low levels of

carbon dioxide Carbon dioxide (chemical formula ) is a chemical compound made up of molecules that each have one carbon atom covalently double bonded to two oxygen atoms. It is found in the gas state at room temperature. In the air, carbon dioxide is transpar ...

cause tetany by altering the

albumin Albumin is a family of globular proteins, the most common of which are the serum albumins. All the proteins of the albumin family are water-soluble, moderately soluble in concentrated salt solutions, and experience heat denaturation. Albumins ...

binding of calcium such that the ionized (physiologically influencing) fraction of calcium is reduced; one common reason for low carbon dioxide levels is

hyperventilation Hyperventilation is irregular breathing that occurs when the rate or tidal volume of breathing eliminates more carbon dioxide than the body can produce. This leads to hypocapnia, a reduced concentration of carbon dioxide dissolved in the blood. ...

. * Low levels of magnesium can lead to tetany. * ''

Clostridium tetani ''Clostridium tetani'' is a common soil bacterium and the causative agent of tetanus. Vegetative cells of ''Clostridium tetani'' are usually rod-shaped and up to 2.5 μm long, but they become enlarged and tennis racket- or drumstick-shaped wh ...

'' toxin, via inhibition of

glycine Glycine (symbol Gly or G; ) is an amino acid that has a single hydrogen atom as its side chain. It is the simplest stable amino acid (carbamic acid is unstable), with the chemical formula NH2‐ CH2‐ COOH. Glycine is one of the proteinogeni ...

-mediated and GABA-ergic

neurotransmission Neurotransmission (Latin: ''transmissio'' "passage, crossing" from ''transmittere'' "send, let through") is the process by which signaling molecules called neurotransmitters are released by the axon terminal of a neuron (the presynaptic neuron), ...

, may lead to tetany. * An excess of

potassium Potassium is the chemical element with the symbol K (from Neo-Latin ''kalium'') and atomic number19. Potassium is a silvery-white metal that is soft enough to be cut with a knife with little force. Potassium metal reacts rapidly with atmosphe ...

in grass

hay Hay is grass, legumes, or other herbaceous plants that have been cut and dried to be stored for use as animal fodder, either for large grazing animals raised as livestock, such as cattle, horses, goats, and sheep, or for smaller domesticat ...

pasture Pasture (from the Latin ''pastus'', past participle of ''pascere'', "to feed") is land used for grazing. Pasture lands in the narrow sense are enclosed tracts of farmland, grazed by domesticated livestock, such as horses, cattle, sheep, or swine ...

can trigger winter tetany, or

grass tetany Grass tetany is a metabolic disease involving magnesium deficiency, which can occur in such ruminant livestock as beef cattle, dairy cattle and sheep, usually after grazing on pastures of rapidly growing grass, especially in early spring. Sympt ...

, in

ruminant Ruminants (suborder Ruminantia) are ungulate, hoofed herbivorous grazing or browsing mammals that are able to acquire nutrients from plant-based food by Enteric fermentation, fermenting it in a specialized stomach prior to digestion, principally ...

s. * Osteomalacia and rickets due to deficiency of vitamin D Metabolic alkalosis with hypokalemia like Gitelman syndrome and Bartter's syndrome can cause tetany. Vomiting induced alkalosis and hyperventilation induced respiratory alkalosis also cause tetany because of neuronal irritability.

Pathophysiology

Hypocalcemia Hypocalcemia is a medical condition characterized by low calcium levels in the blood serum. The normal range of blood calcium is typically between 2.1–2.6 mmol/L (8.8–10.7 mg/dL, 4.3–5.2 mEq/L) while levels less than 2.1 mm ...

is the primary cause of tetany. Low ionized calcium levels in the

extracellular fluid In cell biology, extracellular fluid (ECF) denotes all body fluid outside the cells of any multicellular organism. Total body water in healthy adults is about 60% (range 45 to 75%) of total body weight; women and the obese typically have a lower ...

increase the permeability of neuronal membranes to sodium ion, causing a progressive depolarization, which increases the possibility of action potentials. This occurs because calcium ions interact with the exterior surface of

sodium channels Sodium channels are integral membrane proteins that form ion channels, conducting sodium ions (Na+) through a cell's membrane. They belong to the superfamily of cation channels and can be classified according to the trigger that opens the chann ...

in the plasma membrane of

nerve cells A neuron, neurone, or nerve cell is an electrically excitable cell that communicates with other cells via specialized connections called synapses. The neuron is the main component of nervous tissue in all animals except sponges and placozoa. ...

and hypocalcemia effectively increases

resting potential A relatively static membrane potential which is usually referred to as the ground value for trans-membrane voltage. The relatively static membrane potential of quiescent cells is called the resting membrane potential (or resting voltage), as opp ...

(rendering the cells more excitable) since less positive charge is present extracellularly. When calcium ions are absent the voltage level required to open voltage gated sodium channels is significantly altered (less excitation is required). If the plasma Ca²⁺ decreases to less than 50% of the normal value of 9.4 mg/dl, action potentials may be spontaneously generated, causing contraction of peripheral skeletal muscles. Hypocalcemia is not a term for tetany but is rather a cause of tetany.

Diagnosis

French Professor

Armand Trousseau Armand Trousseau (14 October 1801 – 23 June 1867) was a French internist. His contributions to medicine include Trousseau sign of malignancy, Trousseau sign of latent tetany, Trousseau–Lallemand bodies (an archaic synonym for Bence Jones ...

(1801–1867) devised the maneuver of occluding the

brachial artery The brachial artery is the major blood vessel of the (upper) arm. It is the continuation of the axillary artery beyond the lower margin of teres major muscle. It continues down the ventral surface of the arm until it reaches the cubital fossa ...

by squeezing, to trigger cramps in the fingers. This is now known as the

Trousseau sign of latent tetany Trousseau sign of latent tetany is a medical sign observed in patients with low calcium. From 1 to 4 percent of normal patients will test positive for Trousseau's sign of latent tetany. This sign may be positive before other manifestations of hypo ...

. Also, tetany can be demonstrated by tapping anterior to the ear, at the emergence of the facial nerve. A resultant twitch of the nose or lips suggests low calcium levels. This is now known as the

Chvostek sign The Chvostek sign () is a clinical sign that someone may have a low blood calcium level (a decreased serum calcium, called hypocalcemia). The Chvostek sign is the abnormal twitching of muscles that are activated (innervated) by the facial nerve (a ...

. EMG studies reveal single or often grouped motor unit discharges at low discharge frequency during tetany episodes.

References

External links

* * * Harrison's Principles of Internal Medicine 16th Edition – Dennis L. Kasper, Eugene Braunwald, Stephen Hauser, Dan Longo, J. Larry Jameson, Anthony S. Fauci. {{Nervous and musculoskeletal system symptoms and signs Symptoms and signs: Nervous system Tetanus