With a disorder of calcium-phosphorus metabolism, which accompanies moderate or severe rickets, 4% of children develop spasmophilia, which is also called childhood 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 seizures. It is detected, as a rule, in the period from three months of age to two years. One of the brightest manifestations of a developing ailment is the symptoms of Hvostek, Trousseau and Lust, helping to find out the severity of the ongoing disease. About how these symptoms are determined and how they are treated, we will discuss later in the article.
How are spasmophilic symptoms checked?
To check for the presence of Khvostek symptom, also called the facial nerve phenomenon, the child is placed on a bed without a pillow. The legs should be straightened, and the hands should lie along the body.
The symptom is checked by lightly hammering with a percussion hammer or fingers at the site of the trigeminal nerve exit (above the zygomatic arch). If the patient experiences involuntary twitching of the eyelid and the corner of the upper lip, then the symptom mentioned is considered positive. He, by the way, is tested on both cheekbones.
Symptoms of the tail have 3 degrees of manifestation:
- Muscle contraction throughout the innervation of the facial nerve.
- Muscle contraction 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 manifests the first degree of the symptom even from a light touch in 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.
- The symptom of Trousseau is found by squeezing the middle of the child's shoulder. In this case, the doctor should try to capture as many soft tissues of his hand as possible. If, as a result of this (about 2-3 minutes after squeezing), the fingers of the patient take a forced position called the “obstetrician’s hands” (that is, the thumb is brought to the palm, the index and middle fingers are bent, and the ring and little fingers are bent), then the symptom considered positive. To check its presence in older children or in adults, you can use the cuff to measure blood pressure, pumping air into it until the pulse stops.
- Lust's symptom is checked with a hammer, which is tapped behind the head of the tibia, or by compression of the calf muscle in the region of the Achilles tendon. If the patient has an involuntary abduction of the foot (the “ballerina’s leg”), then the symptom can be considered positive. It is checked on both limbs.
Symptoms of Hvostek, Trousseau, Lust are considered spasmophilic. They become positive if a sick child has a change in the amount of calcium responsible for muscle contractions in the blood. This can lead not only to the presence of rickets, but also other diseases.
What is tetany
Symptoms of Hvostek and Trousseau are signs of spasmophilia (tetany). This disease is characterized by increased nervous excitability, manifested by convulsions of the muscles of the limbs or larynx. Most often, this pathology is observed in boys in the first six months of life.
And the biological basis of this disease is the low level of ionized calcium in the blood of the child.
What is the danger of a tailtail symptom in children
Photos of children with tetany help to understand what are the signs of the disease. The main one is laryngospasm, which is expressed by difficulty breathing, pallor of the 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, ocular, etc.
But the most severe sign of the disease is considered an attack of eclampsia - clonic-tonic seizures, starting with twitching of the muscles of 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 is observed. Eclampsia is dangerous with the possibility of respiratory arrest or heart failure.
Who can get tetany
In the first days of life, convulsive conditions and hypocalcemia most often occur in babies born prematurely, in twins, as well as in those who have experienced jaundice or an infectious disease.
Khvostek's symptom in children of the first months of life can be triggered by a decrease in calcium intake in the child's body, and an increase in calcitonin secretion. Doctors also associate this condition with impaired intake of phosphorus and calcium when the baby is abruptly transferred to cow's milk, as well as (in rare cases) with a deficiency of vitamin D and calcium in the mother's body.
As a rule, in babies hypocalcemia is manifested by neuromuscular irritability, convulsions, vomiting, tachycardia and respiratory symptoms.
Tetany treatment
Attacks of eclampsia require emergency care for the child, and in case of respiratory or cardiac arrest, resuscitation.
For any manifestations of tetany, anticonvulsants are prescribed for the child (Sibazone intramuscularly or intravenously, Sodium oxybarbutyrate intramuscularly, Phenobarbital rectally in suppositories or orally, etc.). Intravenous administration of 10% solution of calcium gluconate or intramuscular 25% solution of magnesium sulfate is also indicated.
Spasmophilia, which causes the symptoms of Hvostek and Trusso, as a rule, has a favorable prognosis in most cases. The danger is only prolonged laryngospasm, threatening respiratory arrest.
When a child reaches the age of 2-3 years, the pathological condition is eliminated as a result of stabilization of the level of calcium and phosphorus in the blood.
Hypoparathyroidism is a disease that is accompanied by a symptom of the tail.
Khvostek's symptom is also a clear sign of a pathological condition called hypoparathyroidism, in which there is a decrease in the functions of the parathyroid glands. Most often, this problem occurs as a result of an operation for a thyroid gland disease or in the presence of an inflammatory process in it. And sometimes dysfunction can also be caused by infectious processes, such as measles or flu.
In newborns, hypoparathyroidism develops in the event of a congenital absence of parathyroid glands or when their functioning is suppressed by increased secretion of maternal parathyroid hormone in the mother's pregnancy.
In this case, as a rule, a decrease in the calcium content in the blood is detected in the patient in parallel with an increase in the concentration of phosphorus. Outwardly, this is manifested by the already described tetany, intestinal phenomena, anomalies in the growth of teeth, nails and hair, as well as skin changes.
In such cases, the symptoms of Hvostek and Trousseau, along with laboratory tests, help to accurately identify the developed tetanic state and diagnose the patient.
Treatment of hypoparathyroidism
For the treatment of this disease, it is important to consider the causes that caused its appearance, as well as the severity of symptoms. In the acute course of the disease with tetany phenomena, 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 same substance, and the second only 9%.
As a rule, in order to eliminate the symptoms of Hvostek, treatment with calcium preparations is required for at least 10 days. A good effect is the intake of calcium inside, and doctors advise doing this by dissolving the drug in milk, to prevent the development of gastritis.
The chronic state of hypoparathyroidism requires taking vitamin D, starting with a loading dose (200-300 thousand units per day), with mandatory monitoring of the content of phosphorus and calcium in the blood, and after normalizing their level, the dose is reduced to 50 thousand units. per day in children up to a year or up to 125 thousand units. - in patients after a year.
What other diseases do the symptoms of Trusso and Hvostek manifest?
In addition to diseases caused only by a decrease in plasma calcium for any reason, the symptoms of Hvostek, Trousseau and Lust can also be detected with other ailments. These include:
- Neurasthenia with an anxious-suspicious state, manifested in the form of hyperventilation syndrome. The patient at the same time experiences a periodic violation of the breathing rhythm, simulating suffocation, with a sensation of a coma in the throat, lack of air, and sometimes with loss of consciousness and cramps.
- Discirculatory processes, combined with asthenic or astheno-neurotic syndrome, characterized by a state of constant fatigue and nervous exhaustion, as well as headache, sleep disturbances and dizziness.
- Hysteria, epilepsy and other diseases.
Prevention of a violation of the level of calcium in a child
As you have probably already seen, in diseases associated with the Khvostek symptom, treatment in children is reduced to the indispensable restoration of normal levels of calcium and phosphorus in the blood. Therefore, the prevention of these pathologies also requires, first of all, monitoring the concentration of the mentioned substances, which is carried out by district pediatricians.
It is important to create optimal conditions for the development of the fetus in a pregnant woman. To do this, if the expectant mother lives in unsatisfactory social conditions or is at risk (for diabetes mellitus, nephropathy, hypertension and rheumatism), she will be prescribed vitamin D during the last 2 months of pregnancy. nutrition and physical activity.
And for a newborn, so that he grows strong and healthy, the presence of breastfeeding, timely introduction of complementary foods, daily stay in the fresh air, free swaddling, massage, gymnastics and light-air baths is important.