Spectrum of Disorders associated with Tetany

Abstract

Introduction: Awareness regarding the etiological spectrum of tetany is poor among physicians. Because of poor awareness, tetany is underdiagnosed and undertreated. Materials and methods: Databases like PubMed, PubMed Central, Scopus, and Google Scholar are searched to identify peer-reviewed articles on tetany. Case reports, case series, and original articles are analyzed to identify different causes of tetany prevalent in the community. Different causes found are analyzed and tabulated, and finally, a flowchart is made on the approach for diagnosing different underlying pathologies of tetany. Results: Both metabolic and respiratory alkalosis are important causes of tetany because of reduced ionized calcium levels. Gitelman syndrome (GS) is associated with metabolic alkalosis, hypokalemia, hypomagnesemia and hypocalciuria, and frequently causes normocalcemic tetany. Recurrent vomiting and primary hyperaldosteronism also cause tetany due to metabolic alkalosis. Hyperventilation syndrome (HVS) leads to respiratory alkalosis and is a frequent cause of tetany. Hyperventilation-induced tetany is also seen after spinal anesthesia and in respiratory disorders like asthma. Vitamin D deficiency (VDD), primary hypoparathyroidism, and pseudohypoparathyroidism (PHP) (1a, 1b, and 2) cause hypocalcemic tetany. Hypomagnesemia causes hypocalcemia and tetany due to peripheral parathyroid hormone resistance and impaired parathyroid hormone secretion. Drugs causing tetany include bisphosphonates, denosumab, cisplatin, antiepileptics, aminoglycosides, diuretics, etc. Tetany is also seen in acute pancreatitis, dengue, falciparum malaria, hyperemesis gravidarum, tumor lysis syndrome (TLS), massive blood transfusion, etc. Conclusion: The spectrum of disorders associated with tetany is diverse. Awareness of different causes will help early and proper diagnosis of tetany.

Tetany in a Young Female Not Resulting From Hypocalcemia

“…In our patient, a diagnosis was made depending on the clinical presentation, and the intervention was directed toward the most common causes of tetany, which include hypocalcemia, hypomagnesemia hypokalemia, and alkalosis [6]. Other conditions that may lead to tetany include recurrent vomiting, acute pancreatitis, anxiety with hyperventilation, vitamin D deficiency, hypoparathyroidism, and malabsorption disorders, such as celiac and Crohn's diseases due to loss of gastrointestinal electrolytes (calcium, magnesium, potassium, and phosphorus), which are secondary to diarrhea [6][7][8][9][10][11]. The possible causes of tetany in our patient were multifactorial.…”

“…The possible causes of tetany in our patient were multifactorial. She had anxiety and tachypnea, which led to respiratory alkalosis; she also had recurrent vomiting, which had occurred more than 20 times per day [8,9]. Metabolic and respiratory alkalosis increases the binding of ionized calcium to albumin and may cause tetany with normal total and adjusted calcium levels [9].…”

Healthcare 4.0 implementation: opportunities and challenges in the healthcare sector

“…Secondly, in the opinion of experts, there is little relevance in the assertion that top management is the one who creates strategies for the implementation of Healthcare 4.0 (question 13, average: 7.12), contrary to Sanal et al (2019) and which was partially agreed by the experts (CV: 30.6%). Implementing Healthcare 4.0 requires the participation of the entire organization, not only top management.…”

“…The Healthcare 4.0 adoption allows better control, which can bring cost savings to the organization (BARDHAN; THOUIN, 2013;BATES et al, 2014;WANG et al, 2018b), senior management is the one who should create strategies for the implementation of Healthcare 4.0 (SANAL et al, 2019), and should create a collaborative environment to disseminate Healthcare 4.0 in their respective departments, encouraging everyone to collaborate in this digital transformation.…”

“…Its adoption also optimizes and improves resource allocation (AL-JAROODI et al, 2020;BATES et al, 2014;DUC et al, 2023;WANG et al, 2018), allowing the mitigation of adverse events (SANAL et al, 2019), and the improvement in organizational culture through greater interaction between all those involved (ACHARYULU, 2011;CAVALLONE;PALUMBO, 2020;MANOGARAN et al, 2017). Healthcare 4.0 allows a better interaction between health professionals (multidisciplinary team) as well with patients (MEISTER et al, 2019), improving the work routine of health professionals (PAN et al, 2019;TORTORELLA et al, 2020b).…”