Tetany

By: Hannah Gilman

What is it?

•Muscle cramps, spasms or tremors•Can occur anywhere

▫Face, fingers, calves•Due to low calcium levels: hypocalcemia

▫Ca concentration in extracellular fluids drops

▫Affects the nervous system▫Sending impulses to skeletal muscles

Hyperventilation •Removes too much CO2: resulting in

respiratory alkalosis (lower H+ and increased pH)

•Increases Calcium proteinate and lowers free Ca++

•Increased excitability causes spontaneous tingling in fingers and toes due to increased sensitivity in the motor axons and peripheral nerves

Parathyroid hormone regulates Ca++ Tetany is a major sign of hypoparathyroidism

Causes

•Diarrhea•Kidney disease•Thyroid or pancreas

problems•Pregnancy and breast

feeding•Malnutrition•Vitamin D deficiency•Some medications•Calcium deficiency

Symptoms of Tetany

Non-Severe Severe

• Abdominal pain• Chronic diarrhea• Muscle pain• Tingling in hands or feet• Twitching fingers

• Loss of muscle coordination

• Loss/change in vision• Paralysis• Seizures• Slurred speech• Sudden difficulty with

memory, thinking, talking, writing or reading

• Sudden weakness or numbness on one side

Who Does it Affect?•Anyone

▫As a consequence of sustained hyperventilation or following excessive

vomiting▫Often from an endocrine disorder

•Neonatal, children, cows, chickens and dogs

•Occurs more in temperate zones/winter •Marathoners •Anorexic or bulimic •Old people

Treatment

•Detection of low calcium levels is important▫Tetany can be fatal if it involves laryngeal

or pharyngeal muscles; which blocks the airway

•IV Treatment▫Calcium carbonate is used in the initial

stage of Hypocalcemia▫Calcium gluconate is used for muscle

cramps or nerve weakness▫Calcium chloride is for patients in serious

condition

CalciumFactors enhancing absorption

Factors that limit absorption

• Parathyroid hormone• Glucose and lactose• Digestive motility• Vitamin D & K

• Large amounts of phytic acid

• Excess of phosphorus and magnesium in diet

• Polyphenols in tea• Vitamin D deficiency• Diarrhea • Old age

Age 0-6 mo

7-12mo

1-3 yr 4-8 yr 9-18 yr

19-50 yr

Over 50 yr

Daily Calcium Intake

210 mg

270 mg

500 mg

800 mg

1300 mg

1000 mg

1200 mg

* Upper limit 2500 mg

How vitamin D & Calcium work together

•Vitamin D facilitates Ca absorption in the intestine▫ By going thru the intestine and into the

blood stream•Helps reclaim Ca in kidneys•1% of the body’s Ca is in the blood

plasma, the rest is in the bones• RDA Calcium: ~1000mg•RDA vitamin D: ~600IU

Where they can be found

Calcium Vitamin D

• Yogurt: 450 mg• Parmesan cheese: 390 mg• 1% milk: 300 mg• Spinach: 250 mg• Salmon: 210 mg• Chocolate pudding: 160

mg• Tofu: 140 mg• Others: cheese, kale, soy

milk, energy bars

• The Sun: 400 IU/15min• Salmon: 238 IU• Sardines: 136 IU• Canned tuna: 136 IU• 1% milk: 99 IU• Mushrooms: 73 IU• Special K cereal: 30 IU• Others: cheeses, cereal,energy bars, eggs, butter,

liver

Diet Plan: Day 1Breakfas

tFood Ca (mg)

VitD (IU)

VitK(mg)

Kcal

Yogurt 419 0 537 208

Fortified milk

285 105 366 122

Grape nut flakes

11 401 99 106

Banana 6 0 422 105

TOTALS 721 506 1424

541

Food Ca (mg)

VitD (IU)

VitK (mg)

Kcal

Shrimp cocktail

91 147 23 218

Spinach 500 0 334 14

Swiss cheese

214 12 21 103

Mushrooms

1 27 110 8

Italian dressing

8 0 28 14

TOTALS 814 186 516 357

Lunch

Food Ca (mg)

VitD (IU)

VitK (mg)

Kcal

Chocolate milkshake

188 58 250 211

Snack

Diet Plan: Day 1

Dinner

Food Ca (mg)

VitD (IU)

VitK (mg)

Kcal

Brown Rice

0 0 0 160

Salmon 420 476 704 254

Kale 90 0 299 34

Yam 26 0 1224

176

Sour cream

40 0 0 60

Fortified milk

570 210 732 244

TOTALS 1146

686 2959

928

Ca (mg)

VitD (IU)

VitK (mg)

Kcal

2869

1436

5149

2037

Totals for the Day

Diet Plan: Day 2Breakfas

tFood Ca (mg)

VitD (IU)

VitK (mg)

Kcal

Cocoa Pebbles

40 40 42 115

Chocolate soy milk

300 120 350 140

Kiwi 60 0 552 108

Honey peanut bar

100 80 115 200

TOTALS 500 240 1059

563

Food Ca (mg)

VitD (IU)

VitK (mg)

Kcal

Grilled cheese on whole wheat

439 11 264 431

Chili w/beans

120 0 934 287

TOTALS 559 11 1198 718

Lunch

Food Ca (mg)

VitD (IU)

VitK (mg)

Kcal

Vanilla milkshake

203 61 290 185

Snack

Diet Plan: Day 2

Food Ca (mg)

VitD (IU)

VitK (mg)

Kcal

Tuna 28 272 620 312

Spinach 500 0 334 14

Muenster cheese

203 0 38 104

Bell Peppers

8 0 158 20

Mushrooms

1 27 110 8

Fortified milk

285 105 366 122

TOTALS 1025

404 1626

580

Dinner

Ca (mg)

VitD (IU)

VitK (mg)

Kcal

2287

716 4173 2046

Totals for the Day

Diet Plan: Day 3

Food Ca (mg)

VitD (IU)

VitK (mg)

Kcal

Omelet w/sausage

64 53 162 167

Fortified milk

285 105 366 122

Whole wheat biscuit

155 10 200 199

Orange 52 0 237 62

TOTALS 556 168 965 550

Food Ca (mg)

VitD (IU)

VitK (mg)

Kcal

Banana crème yogurt

200 80 260 170

Food Ca (mg)

VitD (IU)

VitK (mg)

Kcal

Power Boost smoothie

600 240 810 280

Tuna salad sandwich

76 72 168 326

Mushrooms

3 73 301 21

Ranch 9 1 18 137

TOTALS 688 386 1297 764

Breakfast

Lunch

Snack

Diet Plan: Day 3

Food Ca (mg)

VitD (IU)

VitK (mg)

Kcal

Salmon 420 476 704 254

Baked potato

0 0 0 70

Swiss cheese

224 13 22 103

Spinach 250 0 167 7

Mushrooms

3 73 301 21

Fortified milk

285 105 366 122

TOTALS 1182

667 1560

577

Ca (mg)

VitD (IU)

VitK (mg)

Kcal

2626 1301 4082 2061

Dinner

Totals for the Day

Questions1. What two components must work

together to prevent tetany and osteoporosis?

1. Calcium & Vitamin D

2. What is the best source of vitamin D?2. Sunshine!

3. What percent of Ca is in the blood plasma? Where is the majority held?

3. 1% in the blood plasma & 99% in the bones

Bibliography"Tetany." - Symptoms, Causes, Treatments. Healthgrades, 02 May 2011.

Web. 03 Mar. 2012. <http://www.bettermedicine.com/article/tetany>.Blakemore, Colin. "Tetany." Encyclopedia.com. The Oxford Companion to the

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Dr.John. "Hypocalcemia - Causes, Symptoms and Treatment." Current Health Articles and Tips. Howshealth, 04 Sept. 2010. Web. 03 Mar. 2012. <http://howshealth.com/hypocalcemia/>.

"Calcium Rich Foods, Foods With Calcium." , Calcium Deficiency Symptoms. Fat Free Kitchen, 2005. Web. 03 Mar. 2012. <http://www.fatfreekitchen.com/nutrition/calcium.html>.

Food Composition Table. Boston: McGraw-Hill Higher Education, 2009. Print.

Wardlaw, Gordon M., and Anne M. Smith. Contemporary Nutrition. New York: McGraw-Hill, 2009. Print.

Drezner, Marc, and Kimberly Hoben. "Vitamin D and Calcium Absorption." Sunset Tan. Sunsettan, 17 Sept. 2010. Web. 07 Mar. 2012. <http://www.sunsettan.ca/vitamin-d-and-calcium-absorption/>.