With a disorder of calcium-phosphorus metabolism that 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 detected, as a rule, between the age of three months and up to two years. One of the clearest manifestations of a developing disease are the symptoms of Khvostek, Trousseau and Lust, which help to determine the severity of the disease. How these symptoms are determined and how they are treated will be discussed later in the article.
How spasmophilic symptoms are tested
To test for the presence of the Chvostek symptom, also called the phenomenon of the facial nerve, the child is laid on the bed without a pillow. At the same time, the legs should be straightened, and the arms should lie along the body.
Symptom is checked by light tapping with a percussion hammer or fingers at the exit of the trigeminal nerve (abovezygomatic arch). If the patient experiences an involuntary twitching of the eyelid and the corner of the upper lip, then the symptom mentioned is considered positive. By the way, it is checked on both cheekbones.
Chvostek symptoms have 3 degrees of manifestation:
- Muscle contraction throughout the area of innervation of the facial nerve.
- Muscle contraction at 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 in a child, the first degree of symptom appears even from a light touch in the area of the facial nerve.
Additional ways to check for spasmolytic symptoms
No less indicative in terms of determining the severity of the baby's condition are the symptoms of Trousseau and Lust.
- Trousseau's symptom 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 tissues of his hand as possible. If, as a result of this (approximately 2-3 minutes after squeezing), the patient's fingers take a forced position, called the "obstetrician's hands" (that is, the thumb is brought to the palm, the index and middle fingers are unbent, and the ring and little fingers are bent), then the symptom considered positive. To test for it in older children or adults, you can use a blood pressure cuff by inflating it until the pulse stops.
- Lust's sign is tested with a mallet tapped behind the head of the fibula, or by squeezing the calf muscle at the Achilles tendon. Ifthe patient is observed involuntary abduction of the foot ("ballerina's leg"), then the symptom can be considered positive. It is being tested on both limbs.
The symptoms of Khvostek, Trousseau, Lust are considered spasmophilic. They become positive if there is a change in the amount of calcium in the blood of a sick child, which 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 and Trousseau's symptoms are signs of spasmophilia (tetany). This disease is characterized by increased nervous excitability, manifested by cramps in 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 a low level of ionized calcium in the blood of a child.
What is the dangerous symptom of Chvostek 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 in breathing, pallor of the face, sweating, and sometimes loss of consciousness. Periodic convulsions of the feet and hands (carpopedal spasm) are also characteristic, sometimes lasting several hours. Spasms of other muscle groups are also possible - respiratory, chewing, eye, etc.
But the most severe symptom of the disease is an attack of eclampsia - clonic-tonic convulsions, starting with twitching of the muscles of the face and turning into convulsions of the limbs and laryngospasm. In this case, the child most often loses consciousness, foam appears on the lips, involuntary urination is observed. Eclampsia is dangerous with the possibility of respiratory or cardiac arrest.
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 had jaundice or an infectious disease.
Chvostek's symptom in children of the first months of life can be triggered by both a decrease in the intake of calcium in the child's body and an increase in the secretion of calcitonin. Doctors also associate this condition with a violation of the supply of phosphorus and calcium when the baby is abruptly transferred to feeding with cow's milk, and also (in rare cases) with a lack of vitamin D and calcium in the mother's body.
Typically, infants with hypocalcemia present with neuromuscular irritability, seizures, vomiting, tachycardia, and respiratory symptoms.
Treatment of tetany
Eclampsia attacks require urgent care for the child, and in case of respiratory or cardiac arrest, resuscitation.
In case of any manifestations of tetany, anticonvulsants are prescribed to the child ("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 causing Chvostek and Trousseau's symptoms usually hasfavorable prognosis in most cases. The danger is only prolonged laryngospasm, threatening to stop breathing.
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 Chvostek
Chvostek'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 disease or if there is an inflammatory process in it. And sometimes dysfunction can also be caused by infectious processes, such as measles or influenza.
In newborns, hypoparathyroidism develops in the case of congenital absence of the parathyroid glands or when their functioning is suppressed by increased secretion of parathyroid hormone in the mother's body during pregnancy.
In this case, as a rule, a decrease in the content of calcium in the blood is found in the patient in parallel with an increase in the concentration of phosphorus. And 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 Chvostek and Trousseau, along with laboratory tests, help to accurately identify the developed tetanic condition and diagnose the patient.
Treatmenthypoparathyroidism
For the treatment of this disease, it is important to consider the causes that caused its appearance, as well as the severity of the symptoms. In the acute course of the disease with symptoms of tetany, urgent administration of 10% calcium chloride or calcium gluconate intravenously is recommended. This is done slowly, given that the first mentioned solution contains 27% of the substance of the same name, and the second contains only 9%.
Typically, in order to eliminate the symptoms of Chvostek, treatment with calcium supplements for at least 10 days is required. Oral calcium intake has a good effect, and doctors advise doing this by dissolving the drug in milk to prevent the development of gastritis.
The chronic state of hypoparathyroidism requires the intake of vitamin D, starting with a loading dose (200-300 thousand units per day), with the obligatory control 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 cause symptoms of Trousseau and Chvostek
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 as a hyperventilation syndrome. The patient at the same time experiences a periodic violation of the rhythm of breathing, simulating suffocation, with a feeling of a coma in the throat, lack of air, and sometimes with loss of consciousness and convulsions.
- Discirculatoryprocesses 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 abnormal calcium levels in a child
As you have probably already seen, in diseases that accompany the Chvostek symptom, in children, treatment comes down 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, the control of 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 and living conditions or belongs to the risk group (diabetes mellitus, nephropathy, hypertension and rheumatism), she is prescribed vitamin D in the last 2 months of pregnancy. nutrition and physical activity.
And for a newborn to grow up strong and he althy, it is important to have breastfeeding, timely introduction of complementary foods, daily exposure to fresh air, free swaddling, massage, gymnastics and light-air baths.
