Vitamin D deficiency tetany
Introduction
Introduction to vitamin D deficiency hand and foot convulsions Vitamin D deficiency tetanyofvitaminDeficiency is one of the symptoms associated with vitamin D deficiency rickets, and is often seen in small infants within 6 months. At present, due to the widespread development of prevention of vitamin D deficiency, vitamin D deficiency hand and foot convulsions have occurred less frequently. basic knowledge The proportion of illness: 0.002% Susceptible people: children Mode of infection: non-infectious Complications: throat
Cause
Vitamin D deficiency, the cause of hand and foot convulsions
When vitamin D is deficient, blood calcium decreases and parathyroid gland does not increase compensatory secretions, blood calcium continues to decrease, when total blood calcium is lower than 1.75mmol / L - 1.88mmol / L (<7mg / dl - 7.5mg / dl =, or ionized calcium below 1.0mmol / L (4mg / dl) can cause increased neuromuscular excitability, convulsions. Why the cause of hypoparathyroidism in the body when vitamin D deficiency is not clear, presumably when the baby When the calcium nutrition is poor, the early hyperparathyroidism of vitamin D deficiency increases, in order to maintain normal blood calcium. When vitamin D continues to be deficient, the parathyroid function reflects the transition and is exhausted, resulting in a decrease in blood calcium, so vitamins D deficiency of hand and foot convulsions in Germany, accompanied by the presence of rickets caused by hyperparathyroidism and hypothalamic hypothyroidism caused by low calcium.
Prevention
Vitamin D deficiency, prevention of hand and foot convulsions
Ensuring that children receive a daily vitamin D400 IU is the key to prevention and treatment.
With vitamin D deficiency rickets, pregnant women should be more outdoor sports, diet should be rich in vitamin D, calcium, phosphorus and protein and other nutrients; newborns should be given daily physiological dose after 2 weeks of birth (10 ~ 20g / day ) Vitamin D; infants at the peak of growth and development should take comprehensive preventive measures, that is, to ensure outdoor activities for a certain period of time and to give preventive amounts of vitamin D and calcium and to add complementary foods in time.
Complication
Vitamin D deficiency, hand, foot and convulsion complications Complications
Closely observe the onset of air sputum, throat, and prepare for tracheal intubation or tracheotomy. Once the symptoms are found to be inhaled in time, the throat should immediately pull the tongue out of the mouth, while leaning the head to one side, clearing the mouth and nasal secretions, keeping the airway open, avoiding inhalation of suffocation; The dental pad should be placed between the upper and lower incisors to prevent the tongue from being bitten. If necessary, the tracheal intubation or tracheal incision.
Symptom
Vitamin D deficiency, hand, foot and convulsion symptoms Common symptoms Limb twitching, twitching, convulsions, unconscious lips, facial muscles, convulsions, vitamin D poisoning, body or face...
Mainly for convulsions, throat and hand and foot convulsions, and varying degrees of activity during the period of active rickets.
1. Concealed type
Blood calcium is mostly in the range of 1.75mmol / L - 1.88mmol / L, there is no typical episodes of symptoms, but can be induced by stimulating the neuromuscular.
1st facial nerve sign (Chvostek sign); with the tip of the finger or the percussion cone, the cheeks between the zygomatic arch and the mouth of the child (at the 7th cranial nerve hole) cause the eyelids and mouth twitching to be positive for facial nerve signs, and the neonatal period can be false. Positive.
2 ( ( ( ( ( ( ( ( ( ( ( ( ( ( Per Per Per Per Per Per Per Per Per Per Per Per Per Per Per Per Per Per Per Per Per Per Per Per Per 3 Trousseau sign: Wrap the upper arm with a sphygmomanometer cuff to maintain blood pressure between systolic and diastolic blood pressure. Within 5 minutes, the hand is positive for sputum symptoms.
2, typical episode
Chronic throat and hand and foot convulsions can occur when blood calcium is below 1.75 mmol/L.
1: Sudden limb twitching, squatting on both eyes, facial muscles vibrating, unconsciousness, seizure time can be as short as several seconds, or as long as several minutes or more, the seizure time may be accompanied by perioral hair loss. After the seizure stops, the consciousness recovers, the spirits are sluggish and fall asleep, and the life is as usual after waking up. The number of episodes can be several times a day or several times a day, even as many as ten times a day, generally not fever, only a short eyeball when the episode is light The upper jaw and the facial muscles are twitching and conscious.
2 hand and foot convulsions, can be seen in larger babies, children, sudden hand and foot squat arched, hands curved wrist, fingers straight, thumb inner palm, strong straight, foot ankle straight, toe simultaneously Bend down.
3 throat: more babies, throat muscles and glottis sudden convulsions, difficulty breathing, sometimes sudden suffocation, severe hypoxia or even death, the three symptoms are most common with no heat convulsions.
Examine
Vitamin D deficiency, hand, foot twitch examination
Sudden heat convulsions, and repeated episodes, conscious signs of nervous system after the attack, while the presence of rickets, serum calcium less than 1.75 to 1.88mmol / L (7.5mg / dl) calcium ion <1.0mmol / L.
Diagnosis
Diagnosis and differentiation of vitamin D deficiency hand and foot convulsion
diagnosis
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
Differential diagnosis
Hypoglycemia, infantile spasm, hypomagnesemia, primary hypothyroidism, central nervous system infection, laryngitis.
(1) Other athermal convulsive diseases
Hypoglycemia
Most often occur in the early morning on an empty stomach, often eating less or a history of colds and diarrhea, can occur convulsions, coma. Blood glucose is often below 2.2 mmol/L (40 mg/d1). Immediately after oral administration of syrup or intravenous glucose solution.
2. Infantile snoring
Infancy onset, sudden head and torso flexion during attack, upper limb flexion and adduction, fist, lower limb flexion to the abdomen, with disturbance of consciousness, each seizure from seconds to tens of seconds, often repeated series of episodes, rapid mental decline After 2 to 3 years old, it can be converted to other types of epilepsy. Serum calcium is normal and calcium therapy is ineffective. The EEG showed a high rhythm disorder.
3. Low magnesium convulsions
Common in newborns and babies, mostly artificial feeding, and have a history of inadequate feeding or diarrhea, but also due to defects in hereditary magnesium absorption. When magnesium is less than 0.58mmol/L (1.4mg/dl), low-magnesium convulsions can occur, manifested as hypersensitivity, and tactile and auditory stimuli can cause muscle tremors, paralysis, and even convulsions and heart rhythm disorders. Intramuscular injection of 0.2 ml/kg per 25% magnesium sulfate, 1 to 2 times a day, effective within 1 to 2 days. Clinically, the possibility of low-magnesium convulsions should always be considered for athermal convulsions that are ineffective with calcium.
4. Parathyroid dysfunction
More common in older children, the main features are: low blood calcium, high blood phosphorus, alkaline phosphatase normal or reduced. The clinical manifestations are intermittent convulsions or hand and foot sputum, and the episodes occur once a day or a few weeks.
(two) acute laryngitis
The throat should be differentiated from acute laryngitis, which is caused by viral infection, which is characterized by hoarseness with canine-like cough, inspiratory dyspnea, frequent nighttime onset, fever, no other low-calcium symptoms and signs, blood calcium. Normal, calcium treatment is not effective.
